Price Transparency

OVERVIEW 

In compliance with the Centers for Medicare and Medicaid Services (CMS), Kimble Hospital is making available to the public a copy of its standard charges known as a “Charge Master,” “Charge Description Master” or “CDM”.

Since payment rates for hospital care provided to insured patients are either negotiated with health plans, set by the federal government for Medicare, or set by state governments for Medicaid enrollees, the payments hospitals receive for patient care do not necessarily reflect the prices reflected in the Charge Master.  A patient’s responsibility may vary depending on the payment plans negotiated with insurance companies as well as the patient’s individual and/or family deductibles and co-payments with their insurance plan.  Additionally, uninsured patients are not generally expected to pay the hospital’s standard charges as reflected in the CDM and may be eligible for financial assistance.

The information provided is based on information we have gathered from contracts with managed care commercial insurance plans.  This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons, including the seriousness of your medical condition, actual time the procedure takes and the services and supplies that you receive.

The charges listed here are for services from the Hospital.  They do not reflect the charges for physicians (such as surgeon, anesthesiologist, radiologist, pathologist, etc.) who may be involved in providing particular services to a patient. These charges are billed separately from the individual physician/physicians group.

Kimble Hospital shall not be liable for any difference between charges listed in the price lists and the final bill for services.

AVAILABLE FILES 
There are two files regarding the hospital’s CDM for price transparency. 

The CSV file is a comprehensive, machine-readable file that makes public all standard charge information for all hospital items and services.  This can easily be imported into Microsoft Excel or similar software. This file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

The PDF file is a searchable consumer-friendly format of payer-specific negotiated charge information of 300 “shoppable outpatient services” at the hospital.  The file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

QUESTIONS?

If you have further questions about the Kimble Hospital CDM, please contact our hospital business office at (325) 446-3321 or come by and speak to one of our business office representatives.  Thank you for choosing Kimble Hospital for your health care needs! 

Downloadable CDM and Shoppable Services

Charge Description Master

Shoppable Services

Searchable Shoppable Services

Kimble Hospital Shoppable Services as of 7/1/2024

descriptioncode|1code|1|typecode|2code|2|typecode|3code|3|typemodifierssettingdrug_unit_of_measurementdrug_type_of_measurementstandard_charge|grossstandard_charge|discounted_cashstandard_charge|Aetna Commercial|negotiated_dollarstandard_charge|Aetna Commercial|negotiated_percentagestandard_charge|Aetna Commercial|negotiated_algorithmestimated_amount|Aetna Commercialstandard_charge|Aetna Commercial|methodologyadditional_payer_notes|Aetna Commercialstandard_charge|BCBS|HMO|negotiated_dollarstandard_charge|BCBS|HMO|negotiated_percentagestandard_charge|BCBS|HMO|negotiated_algorithmestimated_amount|BCBS|HMOstandard_charge|BCBS|HMO|methodologyXXXXXadditional_payer_notes|BCBS|HMOstandard_charge|BCBS|Traditional|negotiated_dollarstandard_charge|BCBS|Traditional|negotiated_percentagestandard_charge|BCBS|Traditional|negotiated_algorithmestimated_amount|BCBS|Traditionalstandard_charge|BCBS|Traditional|methodologyadditional_payer_notes|BCBS|Traditionalstandard_charge|BCBS|PPO|negotiated_dollarstandard_charge|BCBS|PPO|negotiated_percentagestandard_charge|BCBS|PPO|negotiated_algorithmestimated_amount|BCBS|PPOstandard_charge|BCBS|PPO|methodologyadditional_payer_notes|BCBS|PPOstandard_charge|CIGNA Commercial|negotiated_dollarstandard_charge|CIGNA Commercial|negotiated_percentagestandard_charge|CIGNA Commercial|negotiated_algorithmestimated_amount|CIGNA Commercialstandard_charge|CIGNA Commercial|methodologyadditional_payer_notes|CIGNA Commercialstandard_charge|Humana Commercial|negotiated_dollarstandard_charge|Humana Commercial|negotiated_percentagestandard_charge|Humana Commercial|negotiated_algorithmestimated_amount|Humana Commercialstandard_charge|Humana Commercial|methodologyadditional_payer_notes|Humana Commercialstandard_charge|Scott & White Commercial|negotiated_dollarstandard_charge|Scott & White Commercial|negotiated_percentagestandard_charge|Scott & White Commercial|negotiated_algorithmestimated_amount|Scott & White Commercialstandard_charge|Scott & White Commerical|methodologyadditional_payer_notes|Scott & White Commercialstandard_charge|Shannon Commercial|negotiated_dollarstandard_charge|Shannon Commercial|negotiated_percentagestandard_charge|Shannon Commercial|negotiated_algorithmestimated_amount|Shannon Commercialstandard_charge|Shannon Commerical|methodologyadditional_payer_notes|Shannon Commercialstandard_charge|United Commercial|negotiated_dollarstandard_charge|United Commercial|negotiated_percentagestandard_charge|United Commercial|negotiated_algorithmestimated_amount|United Commercialstandard_charge|United Commercial|methodologyadditional_payer_notes|United Commercialstandard_charge|minstandard_charge|maxadditional_generic_notes
SEMI PRIVATE ROOMA103MCDM120RCinpatient10006006000.6999999999 Percent of total billed charges4500999999999Case rate5000999999999Case rate5000999999999Case rate7200.72999999999 Percent of total billed charges7320.732999999999 Percent of total billed charges8500.85999999999 Percent of total billed charges9000.9999999999 Percent of total billed charges1714999999999 Per diem6005000
SWING BED ROOMA103CDM120RCinpatient700420
SEMI PRIVATE WITH TELEMA203MCDM120RCinpatient12007207200.6999999999 Percent of total billed charges4500999999999Case rate5000999999999Case rate5000999999999Case rate8640.72999999999 Percent of total billed charges878.40.732999999999 Percent of total billed charges10200.85999999999 Percent of total billed charges10800.9999999999 Percent of total billed charges1714999999999 Per diem7205000
Swing Bed IsolationA403CDM120RCinpatient1000600
SEMI PRIVATE ISOLATIONA403MCDM120RCinpatient13007807800.6999999999 Percent of total billed charges4500999999999Case rate5000999999999Case rate5000999999999Case rate9360.72999999999 Percent of total billed charges951.60.732999999999 Percent of total billed charges11050.85999999999 Percent of total billed charges11700.9999999999 Percent of total billed charges1714999999999 Per diem7805000
HIB IMMUNIZATION1R1439CDM90648CPT250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
Fluzone High Dose Quadrvlnt2500294CDM90662CPT250RCboth12575750.6999999999 Percent of total billed charges900.72999999999 Percent of total billed charges91.50.732999999999 Percent of total billed charges106.250.85999999999 Percent of total billed charges112.50.9999999999 Percent of total billed charges85.880.687999999999 Percent of total billed charges75112.5
Prevnar 13 0.5ML VIAL414587CDM90670CPT250RCboth596357.6357.60.6999999999 Percent of total billed charges429.120.72999999999 Percent of total billed charges436.270.732999999999 Percent of total billed charges506.60.85999999999 Percent of total billed charges536.40.9999999999 Percent of total billed charges409.450.687999999999 Percent of total billed charges357.6536.4
Pneumovax 202500237CDM90677CPT250RCboth5003003000.6999999999 Percent of total billed charges3600.72999999999 Percent of total billed charges3660.732999999999 Percent of total billed charges4250.85999999999 Percent of total billed charges4500.9999999999 Percent of total billed charges343.50.687999999999 Percent of total billed charges300450
Fluzone reg dose2500295CDM90686CPT250RCboth3521210.6999999999 Percent of total billed charges25.20.72999999999 Percent of total billed charges25.620.732999999999 Percent of total billed charges29.750.85999999999 Percent of total billed charges31.50.9999999999 Percent of total billed charges24.050.687999999999 Percent of total billed charges2131.5
TETANUS/DIP 5ML VIAL414589CDM90698CPT250RCboth16699.699.60.6999999999 Percent of total billed charges119.520.72999999999 Percent of total billed charges121.510.732999999999 Percent of total billed charges141.10.85999999999 Percent of total billed charges149.40.9999999999 Percent of total billed charges114.040.687999999999 Percent of total billed charges99.6149.4
MMRV907100CDM90710CPT250RCboth14184.684.60.6999999999 Percent of total billed charges101.520.72999999999 Percent of total billed charges103.210.732999999999 Percent of total billed charges119.850.85999999999 Percent of total billed charges126.90.9999999999 Percent of total billed charges96.870.687999999999 Percent of total billed charges84.6126.9
TETANUS,TDAP 7 YRS IR OLDER IM30790714CDM90714CPT250RCboth11166.666.60.6999999999 Percent of total billed charges79.920.72999999999 Percent of total billed charges81.250.732999999999 Percent of total billed charges94.350.85999999999 Percent of total billed charges99.90.9999999999 Percent of total billed charges76.260.687999999999 Percent of total billed charges66.699.9
TETANUS,TDAP YEARS OR OLDER IM90715CDM90714CPT250RCboth13882.882.80.6999999999 Percent of total billed charges99.360.72999999999 Percent of total billed charges101.020.732999999999 Percent of total billed charges117.30.85999999999 Percent of total billed charges124.20.9999999999 Percent of total billed charges94.810.687999999999 Percent of total billed charges82.8124.2
PEDIARIX 0.5ML VACCINE414857CDM90723CPT250RCboth2251351350.6999999999 Percent of total billed charges1620.72999999999 Percent of total billed charges164.70.732999999999 Percent of total billed charges191.250.85999999999 Percent of total billed charges202.50.9999999999 Percent of total billed charges154.580.687999999999 Percent of total billed charges135202.5
Hep B Recombivax 10MG/ML 1ML414581CDM90746CPT250RCboth2151291290.6999999999 Percent of total billed charges154.80.72999999999 Percent of total billed charges157.380.732999999999 Percent of total billed charges182.750.85999999999 Percent of total billed charges193.50.9999999999 Percent of total billed charges147.710.687999999999 Percent of total billed charges129193.5
COVID Vaccine Admin 1st dose2500001ACDM0011ACPT250RCboth0.01
NS 0.9% 10 ML2500153CDMA4216CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
SALINE LOCK STARTCT3CDMA4217CPT250RCboth10663.663.60.6999999999 Percent of total billed charges76.320.72999999999 Percent of total billed charges77.590.732999999999 Percent of total billed charges90.10.85999999999 Percent of total billed charges95.40.9999999999 Percent of total billed charges72.820.687999999999 Percent of total billed charges63.695.4
SANTYL Ointment414551CDMA6250CPT250RCboth481288.6288.60.6999999999 Percent of total billed charges346.320.72999999999 Percent of total billed charges352.090.732999999999 Percent of total billed charges408.850.85999999999 Percent of total billed charges432.90.9999999999 Percent of total billed charges330.450.687999999999 Percent of total billed charges288.6432.9
PROTONIX 40MG IV/IM414836CDMC9113CPT250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
ADENOSINE 1 MG2500079CDMJ0153CPT250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
EPINEPHRINE 1:10,000 10ML SYG414418CDMJ0171CPT250RCboth2213.213.20.6999999999 Percent of total billed charges15.840.72999999999 Percent of total billed charges16.10.732999999999 Percent of total billed charges18.70.85999999999 Percent of total billed charges19.80.9999999999 Percent of total billed charges15.110.687999999999 Percent of total billed charges13.219.8
EPINEPHRINE 1:1000 1 ML AMP414416CDMJ0171CPT250RCboth3621.621.60.6999999999 Percent of total billed charges25.920.72999999999 Percent of total billed charges26.350.732999999999 Percent of total billed charges30.60.85999999999 Percent of total billed charges32.40.9999999999 Percent of total billed charges24.730.687999999999 Percent of total billed charges21.632.4
AMIODARONE 50MG/1ML 3ML inj414868CDMJ0282CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
NEXTERONE IV 360MG/200ML2500008CDMJ0282CPT250RCboth8551510.6999999999 Percent of total billed charges61.20.72999999999 Percent of total billed charges62.220.732999999999 Percent of total billed charges72.250.85999999999 Percent of total billed charges76.50.9999999999 Percent of total billed charges58.40.687999999999 Percent of total billed charges5176.5
NEXTERONE IV 150MG/100ML2500009CDMJ0282CPT250RCboth8551510.6999999999 Percent of total billed charges61.20.72999999999 Percent of total billed charges62.220.732999999999 Percent of total billed charges72.250.85999999999 Percent of total billed charges76.50.9999999999 Percent of total billed charges58.40.687999999999 Percent of total billed charges5176.5
UNASYN 3GM VIAL414833CDMJ0295CPT250RCboth3822.822.80.6999999999 Percent of total billed charges27.360.72999999999 Percent of total billed charges27.820.732999999999 Percent of total billed charges32.30.85999999999 Percent of total billed charges34.20.9999999999 Percent of total billed charges26.110.687999999999 Percent of total billed charges22.834.2
SUCCINYLCHOLINE 20MG/ML 10ML VIAL414617CDMJ0330CPT250RCboth5432.432.40.6999999999 Percent of total billed charges38.880.72999999999 Percent of total billed charges39.530.732999999999 Percent of total billed charges45.90.85999999999 Percent of total billed charges48.60.9999999999 Percent of total billed charges37.10.687999999999 Percent of total billed charges32.448.6
ZITHROMAX 500 MG VIAL414495CDMJ0456CPT250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
ATROPINE 1MG/10ML 10 ML SYG414413CDMJ0461CPT250RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
BICILLIN LA 1200000U/2ML 2ML INJ414577CDMJ0561CPT250RCboth339203.4203.40.6999999999 Percent of total billed charges244.080.72999999999 Percent of total billed charges248.150.732999999999 Percent of total billed charges288.150.85999999999 Percent of total billed charges305.10.9999999999 Percent of total billed charges232.890.687999999999 Percent of total billed charges203.4305.1
CALCIUM GLUCONATE 10% 10ml vial414434CDMJ0610CPT250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
CEFAZOLIN INJ 500 MG2500093CDMJ0690CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
CEFEPIME 1gm414920CDMJ0692CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
Ceftriaxone 500mg vial2500012CDMJ0696CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
CEFTRIAXONE SODIUM 250MG414489CDMJ0696CPT250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Ceftriaxone 1GM VIAL2500013CDMJ0696CPT250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
CEFTIN 500 MG414959CDMJ0697CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
BETAMETHASONE 6 MG/ML INJ4141000CDMJ0702CPT250RCboth10361.861.80.6999999999 Percent of total billed charges74.160.72999999999 Percent of total billed charges75.40.732999999999 Percent of total billed charges87.550.85999999999 Percent of total billed charges92.70.9999999999 Percent of total billed charges70.760.687999999999 Percent of total billed charges61.892.7
Ciprofloxacin 400mg/200ml 200ml liquid414497CDMJ0744CPT250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
COMPAZINE 10MG/2ML VIAL414830CDMJ0780CPT250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
PROCHLORPERAZINE 10MG/2ML VIAL414822CDMJ0780CPT250RCboth4527270.6999999999 Percent of total billed charges32.40.72999999999 Percent of total billed charges32.940.732999999999 Percent of total billed charges38.250.85999999999 Percent of total billed charges40.50.9999999999 Percent of total billed charges30.920.687999999999 Percent of total billed charges2740.5
ARANESP 200MCG 0.4ML SYRINGE414828CDMJ0881CPT250RCboth30091805.41805.40.6999999999 Percent of total billed charges2166.480.72999999999 Percent of total billed charges2202.590.732999999999 Percent of total billed charges2557.650.85999999999 Percent of total billed charges2708.10.9999999999 Percent of total billed charges2067.180.687999999999 Percent of total billed charges1805.42708.1
DEPOMEDROL 40MG/1 ML 1ML VIAL414443CDMJ1030CPT250RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
DEPO PROVERA PER 1MG414444CDMJ1050CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DEXAMETHASONE INJ 4 MG (Decadron)2500102CDMJ1100CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DECADRON 4 MG/1 ML VIAL414437ACDMJ1100CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
DIGOXIN 250MCG/1ML 2ML414428CDMJ1160CPT250RCboth137.87.80.6999999999 Percent of total billed charges9.360.72999999999 Percent of total billed charges9.520.732999999999 Percent of total billed charges11.050.85999999999 Percent of total billed charges11.70.9999999999 Percent of total billed charges8.930.687999999999 Percent of total billed charges7.811.7
PHENYTOIN 100/2ML VIAL414463CDMJ1165CPT250RCboth3.021.811.810.6999999999 Percent of total billed charges2.170.72999999999 Percent of total billed charges2.210.732999999999 Percent of total billed charges2.570.85999999999 Percent of total billed charges2.720.9999999999 Percent of total billed charges2.070.687999999999 Percent of total billed charges1.812.72
DILAUDID 2MG ML AMP414827CDMJ1170CPT250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
DIPHENHYDRAMINE 50MG/1ML 1ml VIAL414439CDMJ1200CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
INVANZ 1gm414921CDMJ1335CPT250RCboth3802282280.6999999999 Percent of total billed charges273.60.72999999999 Percent of total billed charges278.160.732999999999 Percent of total billed charges3230.85999999999 Percent of total billed charges3420.9999999999 Percent of total billed charges261.060.687999999999 Percent of total billed charges228342
GENTAMYCIN 80MG/2 ML VIAL414826CDMJ1580CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
HALDOL 5MG/ML 1 ML AMP414447CDMJ1630CPT250RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
Heparin Lock Flush 100u/ml 100units/5ml414898CDMJ1642CPT250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
HEPARIN 5000 UNITS414449CDMJ1644CPT250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
LOVENOX 30 MG injection414970CDMJ1650CPT250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
LOVENOX 60 MG SYG414427CDMJ1650CPT250RCboth2917.417.40.6999999999 Percent of total billed charges20.880.72999999999 Percent of total billed charges21.230.732999999999 Percent of total billed charges24.650.85999999999 Percent of total billed charges26.10.9999999999 Percent of total billed charges19.920.687999999999 Percent of total billed charges17.426.1
LOVENOX 40MG SYG414426CDMJ1650CPT250RCboth7343.843.80.6999999999 Percent of total billed charges52.560.72999999999 Percent of total billed charges53.440.732999999999 Percent of total billed charges62.050.85999999999 Percent of total billed charges65.70.9999999999 Percent of total billed charges50.150.687999999999 Percent of total billed charges43.865.7
Humalog Insulin 1UNIT414612CDMJ1815CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LANTUS 100UNITS/1ML 1000units inj414611CDMJ1815CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
INSULIN PER 5 UNITS2500128CDMJ1815CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Humalog insulin pen2500202CDMJ1815CPT250RCboth15391.891.80.6999999999 Percent of total billed charges110.160.72999999999 Percent of total billed charges1120.732999999999 Percent of total billed charges130.050.85999999999 Percent of total billed charges137.70.9999999999 Percent of total billed charges105.110.687999999999 Percent of total billed charges91.8137.7
KETORALAC INJ 15 MG2500136CDMJ1885CPT250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
KETOROLAC 15MG VIAL414508CDMJ1885CPT250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
FUROSEMIDE 40Mg/4ML 4ML Vial414446CDMJ1940CPT250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
KEPPRA INJ 10 MG2500139CDMJ1953CPT250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Levaquin 750mg/150ml Ivpb414966CDMJ1956CPT250RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
LEVAQUIN 250MG IVPB414785CDMJ1956CPT250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
LEVAQUIN 500MG IVPB414500CDMJ1956CPT250RCboth4426.426.40.6999999999 Percent of total billed charges31.680.72999999999 Percent of total billed charges32.210.732999999999 Percent of total billed charges37.40.85999999999 Percent of total billed charges39.60.9999999999 Percent of total billed charges30.230.687999999999 Percent of total billed charges26.439.6
LIDOCAINE 1% 20ML414406CDMJ2001CPT250RCboth0.01
LIDOCAINE 2%MDV 20/50ML INJ414407CDMJ2001CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
XYLOCAINE/EPI 1% 20 ML INJ414410CDMJ2001CPT250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
LIDOCAINE 2GM PREMIX414506CDMJ2001CPT250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
XYLOCAINE/EPI 2% 20 ML INJ414411CDMJ2001CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
LORAZEPAM 2MG/ML 1ml inj414689CDMJ2060CPT250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
DEMEROL 50MG LL SYG414674CDMJ2175CPT250RCboth1710.210.20.6999999999 Percent of total billed charges12.240.72999999999 Percent of total billed charges12.440.732999999999 Percent of total billed charges14.450.85999999999 Percent of total billed charges15.30.9999999999 Percent of total billed charges11.680.687999999999 Percent of total billed charges10.215.3
MEROPENEM INJ 100 MG2500147CDMJ2185CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
MIDAZOLAM 2MG/2ML 2 ML VIAL414642CDMJ2250CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
MORPHINE 4MG LL SYG414677CDMJ2270CPT250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
MORPHINE 2MG LL SYG414676CDMJ2270CPT250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
MORPHINE 10MG LL SYG414678CDMJ2270CPT250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
NALOXONE 0.4MG TUBE414468CDMJ2310CPT250RCboth3923.423.40.6999999999 Percent of total billed charges28.080.72999999999 Percent of total billed charges28.550.732999999999 Percent of total billed charges33.150.85999999999 Percent of total billed charges35.10.9999999999 Percent of total billed charges26.790.687999999999 Percent of total billed charges23.435.1
OCTREOTIDE INJ 25 MCG2500158CDMJ2354CPT250RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
Orphenadrine Citrate 30mg/1ml 2ml Inj414307CDMJ2360CPT250RCboth3319.819.80.6999999999 Percent of total billed charges23.760.72999999999 Percent of total billed charges24.160.732999999999 Percent of total billed charges28.050.85999999999 Percent of total billed charges29.70.9999999999 Percent of total billed charges22.670.687999999999 Percent of total billed charges19.829.7
ONDANSETRON INJ 1 MG2500160CDMJ2405CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ONDANSETRON 1MG/ML INJECTION414849CDMJ2405CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Orbactiv 400 mg2500212CDMJ2407CPT250RCboth29261755.61755.60.6999999999 Percent of total billed charges2106.720.72999999999 Percent of total billed charges2141.830.732999999999 Percent of total billed charges2487.10.85999999999 Percent of total billed charges2633.40.9999999999 Percent of total billed charges2010.160.687999999999 Percent of total billed charges1755.62633.4
ZOSYN INJ 1.125 GM2500170CDMJ2543CPT250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
PROMETHAZINE UP TO 50MG414462CDMJ2550CPT250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
PHENERGAN 25MG SUPP ER DISP414873CDMJ2550CPT250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
PHENOBARBITAL INJ 130 MG2500164CDMJ2560CPT250RCboth15090900.6999999999 Percent of total billed charges1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges103.050.687999999999 Percent of total billed charges90135
METOCLOPRAMIDE 5MG/1ML 2ML VIAL414460CDMJ2765CPT250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
SOLU MEDROL 40MG ADV414472CDMJ2920CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
SOLU MEDROL 1GM414476CDMJ2920CPT250RCboth7746.246.20.6999999999 Percent of total billed charges55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges52.90.687999999999 Percent of total billed charges46.269.3
SOLU MEDROL 125 MG ADV414474CDMJ2930CPT250RCboth2414.414.40.6999999999 Percent of total billed charges17.280.72999999999 Percent of total billed charges17.570.732999999999 Percent of total billed charges20.40.85999999999 Percent of total billed charges21.60.9999999999 Percent of total billed charges16.490.687999999999 Percent of total billed charges14.421.6
ALTEPLASE 1 MG (activase 100mg)2500075CDMJ2997CPT250RCboth1730810384.810384.80.6999999999 Percent of total billed charges12461.760.72999999999 Percent of total billed charges12669.460.732999999999 Percent of total billed charges14711.80.85999999999 Percent of total billed charges15577.20.9999999999 Percent of total billed charges11890.60.687999999999 Percent of total billed charges10384.815577.2
FENTANYL CITRATE 50mcg/1ml 2ml Inj2507632CDMJ3010CPT250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
IMITREX 6 MG/.5 ML 0.5ML VIAL414451CDMJ3030CPT250RCboth13078780.6999999999 Percent of total billed charges93.60.72999999999 Percent of total billed charges95.160.732999999999 Percent of total billed charges110.50.85999999999 Percent of total billed charges1170.9999999999 Percent of total billed charges89.310.687999999999 Percent of total billed charges78117
TNK 1 MG2500175CDMJ3101CPT250RCboth366219.6219.60.6999999999 Percent of total billed charges263.520.72999999999 Percent of total billed charges267.910.732999999999 Percent of total billed charges311.10.85999999999 Percent of total billed charges329.40.9999999999 Percent of total billed charges251.440.687999999999 Percent of total billed charges219.6329.4
BRETHINE 1MG/ML AMP414440CDMJ3105CPT250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
TOBRAMYCIN 80MG/2ML VIAL414492CDMJ3260CPT250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
KENALOG INJ 1 MG2500134CDMJ3301CPT250RCboth2816.816.80.6999999999 Percent of total billed charges20.160.72999999999 Percent of total billed charges20.50.732999999999 Percent of total billed charges23.80.85999999999 Percent of total billed charges25.20.9999999999 Percent of total billed charges19.240.687999999999 Percent of total billed charges16.825.2
KENALOG 40 MG VIAL414455CDMJ3301CPT250RCboth6941.441.40.6999999999 Percent of total billed charges49.680.72999999999 Percent of total billed charges50.510.732999999999 Percent of total billed charges58.650.85999999999 Percent of total billed charges62.10.9999999999 Percent of total billed charges47.40.687999999999 Percent of total billed charges41.462.1
DIAZEPAM 10MG/2ML 2ML carp414636CDMJ3360CPT250RCboth7042420.6999999999 Percent of total billed charges50.40.72999999999 Percent of total billed charges51.240.732999999999 Percent of total billed charges59.50.85999999999 Percent of total billed charges630.9999999999 Percent of total billed charges48.090.687999999999 Percent of total billed charges4263
VANCOMYCIN INJ 500 MG2500182CDMJ3370CPT250RCboth2012120.6999999999 Percent of total billed charges14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges13.740.687999999999 Percent of total billed charges1218
HYDROXYZINE 50MG VIAL414453CDMJ3410CPT250RCboth5432.432.40.6999999999 Percent of total billed charges38.880.72999999999 Percent of total billed charges39.530.732999999999 Percent of total billed charges45.90.85999999999 Percent of total billed charges48.60.9999999999 Percent of total billed charges37.10.687999999999 Percent of total billed charges32.448.6
THIAMINE INJ 100 MG2500177CDMJ3411CPT250RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
CYANOCOBALAMIN 1000 MCG414437CDMJ3420CPT250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
MAGNESIUM SULFATE 5% INJ2500143CDMJ3475CPT250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
KCL 2 MEQ2500156CDMJ3480CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
NS 20MG POTASSIUM 1000ML IV BAG414728CDMJ3480CPT250RCboth2012120.6999999999 Percent of total billed charges14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges13.740.687999999999 Percent of total billed charges1218
SOD CHLORIDE INH 3ML/UD414346CDMJ3535CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Spiriva HandiHaler kit 18MCG2500018CDMJ3535CPT250RCboth14587870.6999999999 Percent of total billed charges104.40.72999999999 Percent of total billed charges106.140.732999999999 Percent of total billed charges123.250.85999999999 Percent of total billed charges130.50.9999999999 Percent of total billed charges99.620.687999999999 Percent of total billed charges87130.5
NS 100CC IV BAG583620CDMJ7050CPT250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
DEXTROSE 50% 50ML SYG414572CDMJ7060CPT250RCboth2515150.6999999999 Percent of total billed charges180.72999999999 Percent of total billed charges18.30.732999999999 Percent of total billed charges21.250.85999999999 Percent of total billed charges22.50.9999999999 Percent of total billed charges17.180.687999999999 Percent of total billed charges1522.5
ACETYLCYSTEIN 10% /vial414352CDMJ7604CPT250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
ALBUTEROL SULFATE 2 MG TAB414924CDMJ7609CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
ALBUTEROL .083% 3ML UD414349CDMJ7613CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
XOPENEX 0.63MG/3ML 3ML NEB414711CDMJ7614CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
XOPENEX UD 1.25MG414824CDMJ7614CPT250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
DUONEB inhalation .5/2.5mg inh414961CDMJ7620CPT250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
DEXAMETHASONE 4MG TAB414063CDMJ8540CPT250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
INFLUENZA SHOT414746CDMQ2038CPT250RCboth2515150.6999999999 Percent of total billed charges180.72999999999 Percent of total billed charges18.30.732999999999 Percent of total billed charges21.250.85999999999 Percent of total billed charges22.50.9999999999 Percent of total billed charges17.180.687999999999 Percent of total billed charges1522.5
MARCAINE 0.5% 10ML INJ414408CDMS0020CPT250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
METRONIDAZOLE 500MG (5mg/ml) 500mg/100ml414499CDMS0030CPT250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
ONDANSETRON 4MG ODT TAB414904CDMS0119CPT250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Amoxicillin 250MG/5ML 100ML BTL414693CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Lidociane 2% PF(I/O) Inj4140025CDM250RCboth0.01
NS 0.9% FLUSH EA414404CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TYLENOL ES 500 MG TAB414213CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ACETAMINOPHEN 325 MG TAB414216CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
METFORMIN 500MG TAB414100CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
IBUPROFEN 200MG TAB414145CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CEPHALEXIN 250 MG CAP414114CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LIPITOR 20 MG TAB414127CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
BACITRACIN oint414525CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Gabapentin 300MG CAP414148CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CALCIUM D 600MG tab4140028CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ASPIRIN 325mg414012CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
SLOW MAG 71.5 MG TAB414135CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LEVOTHROID 0.025MG TAB414190CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DOCUSATE CALCIUM 240MG CAP414186CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ZOCOR 20 MG TAB414228CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
FUROSEMIDE 40MG TAB414122CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PREDNISONE 20 MG TAB414165CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Ferrous Sulfate 325 mg TAB414089CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Gabapentin 100 MG CAP414147CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TYLENOL #3 300/30 TAB414662CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
AMOXICILLIN 250 MG CAP414009CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
NORVASC 5 MG TAB414153CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
METOPROLOL TARTRATE 25 MG tab414930CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
METOPROLOL TARTRATE 50MG tab414130CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
THERAGRAN-M TAB414206CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
FUROSEMIDE 20MG TAB414120CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
THIAMINE 100 MG TAB414209CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Norvasc 10 MG2500196CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PREDNISONE 10 MG TAB414164CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
NEOSPORIN OINT UD414524CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
VITAMIN D 1000IU CAP4140022CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
IBUPROFEN 800MG tab414146CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
METRONIDAZOLE 250 MG TAB414092CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CLONIDINE 0.1MG TAB414040CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LEVOTHROID 0.075MG TAB414192CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
BENZONATATE 100MG CAP414201CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ZOLOFT 50 MG TAB414229CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LORAZEPAM 1MG TAB EA414644CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DILTIAZEM 120MG CAP414034CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
BENADRYL 25MG CAP414021CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ALLOPURINOL 100 MG TAB414333CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
FOLIC ACID 1MG TAB414097CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
SIMETHICONE 80 MG TAB414142CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
FLUOR-I-STRIP414552CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CLARITIN 10MG TAB414054CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DILTIAZEM 180 MG CAP414036CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DILTIAZEM 30MG CAP414032CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
MELATONIN 3 MG tab414987CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CYCLOBENZAPRINE 10MG TAB414094CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
HYDRALAZINE 50MG TAB414743CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
OMEGA 3 1000 MG CAPSULE414982CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Magnesium Oxide 400mg tablet2500032CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PAXIL 20 MG TAB414156CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CLEOCIN 150MG CAP414736CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PREDNISOLONE 15MG/5ML 5 ML SYR414389CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ALPRAZOLAM 0.25MG TAB414657CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
HYDROXYZINE Pamoate 25MG TAB414788CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TRAZODONE 50 MG414065CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
HCTZ 25MG TAB414107CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LEVOTHROID 0.1MG TAB414194CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
HYOSCYAMINE SULFATE .125MG TAB414126CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PHENAZOPYRIDINE 100MG TAB414174CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Metamucil 3gm pow/cap414399CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
GUAIFENESIN UD 5ML SYRUP414374CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DULCOLAX 5MG TAB414079CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
AMITRIPTYLINE 25MG TAB414086CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
B-12 TAB 100mcg414017CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DEEP SEA NASAL SPRAY414343CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DULCOLAX 10MG SUPP EA414624CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
VITAMIN C 500MG TAB414739CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
SulfamethTri (Bactrim DS) 800/160MG TAB414018CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ACETAMINOPHEN 650MG SUPP414629CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
GLYCERIN SUPPOS414631CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
NAPROXEN 500 MG414986CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
K-Phos tablet2500034CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ASPIRIN EC 81 mg414013CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CEPASTAT LOZ414051CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
PHENYTOIN 100 MG CAP414070CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
METOCLOPRAMIDE 10MG TAB414177CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TYLENOL 120MG SUPP414627CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TEMAZEPAM 15MG CAP EA414651CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DIAZEPAM 5MG TAB414769CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
LORATADINE SYRUP 5MG/5ML414832CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
DEXTROSE 5% 250 ML2500046CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Naproxen 220 mg2500216CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Pedialyte Popsicle2500220CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ThermoTabs2500222CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Mirapex2500224CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Dicyclomine HCl [Bentyl] 10 mg2500225CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Keppra [Levetiracetam] 500 mg2500231CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
CARAFATE 1GM TAB414037CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
VIT E414081CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ALBUTEROL SYRUP 5CC414357CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
ZINC 220 MG TAB414741CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Vitamin B12 1000 mcg2500068CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Levothyroxine 88mcg2500283CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Propanolol 40mg2500284CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
POTASSIUM CHL 10MEQ CAP414144CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
TOPROL XL 25MG TAB414896CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
LISINOPRIL 10 MG TAB414169CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
TRAMADOL 50 MG TAB414219CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Hydrocodone/APAP 10mg/325mg tab4140035CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
NOVOLOG MIX INSULIN 70/30414949CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
ASPIRIN (Chewable) 81MG414020CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
SINEMENT 25/100MG TAB414181CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Famotidine 20mg/2ml 20mg/2ml inj414900CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
HYDROCODONE APAP 5/325 MG414943CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
MUCINEX/GUAIBID LA 600MG TAB414699CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
CLONAZEPAM 0.5 MG TAB EA414647CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
MECLIZINE 25MG TAB414011CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
NOVOLIN R 100UNITS/1ML 10ML UNITS414608CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
SPIRONOLACTONE 50MG TAB414006CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
ACETAMINOPHEN 325MG SUPP414628CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
IMODIUM 2MG CAP414112CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
FLEET ENEMA414396CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
PROMETHAZINE 25MG TAB414162CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
CEPHALEXIN 125MG/5ML 100 ml susp414891CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
GEMFIBROZIL 600 MG TAB414132CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
DIPHENOXL/AT 2.5/0.025MG TAB414649CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
TUMS TAB414775CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
NYSTATIN SUSP414387CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
NAMENDA 5MG TAB414841CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
MORPHINE SULFATE TABS 15MG414914CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Preparation H Suppositories2500213CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
MIRALAX 17GM UD414384CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
MUCINEX DM 600/30 TAB414848CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
FAMOTINDINE 20MG TAB414158CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
LOSARTAN POTASSIUM 25 MG tab414909CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
MOTRIN CHILDRENS 100mg/5ml 5ML cup414695CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Buspirone HCL 10MG TAB414029CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
IPRATROPIUM BROMIDE 0.5MG/2.5ML INH414348CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
NITROSTAT 0.4MG TAB414151CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
VASOTEC 5 MG TAB414222CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Lactulose (Kristulose) 20GM UD LIQ414383CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
HUMALOG LISPRO2500064CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
FLORINEF 0.1MG TAB414095CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
ISOSORIBIDE MONO ER 30MG tab414111CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
DIFLUCAN 100 MG TAB414825CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
TERAZOSIN 5 MG CAP414994CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
PROCARDIA XL 30MG TAB414170CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Glimepiride 2 mg TAB414007CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
MAG CITRATE 10 oz sol414397CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
ATENOLOL 50 MG TAB414199CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
RIFAMPIN 300 MG CAPSULE414981CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
METHYLPREDNISOLONE (Solu-Medrol) 4MG414139CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
LIDOCAINE VISCOUS 20ML UD LIQ414382CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
ISOSORBIDE DINITRATE 10 MG tab414737CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
FEXOFENADINE HYDROCHLORIDE 60mg414895CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Lidocaine 2% 5mL vial2500234CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
ASPIRIN 300MG SUPP414630CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Amoxicillin 200mg/5 ml Susp2500288CDM250RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
LEVEMIR 100 UNITS PER ML 1000units inj4140033CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
ACETAMINOPHEN UD 160MG/5ML 5ML CUP414394CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Nicotine Patch, 21 MG414734CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Nicotine patch, 14 mg2500022CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
COREG 3.125MG TAB414055CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
COREG 25 MG TAB414812CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Nicotine patch, 7mg2500021CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
NITREK 0.2MG PATCH EA414559CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
HYDROCORTISONE 1% 30GM CRM414513CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
GUAIFENESIN DM UD 5ML SYRUP414376CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
AMIODARONE 200MG TAB414787CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Mineral oil enema2500201CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
TOPIRAMATE 25 MG TAB4140015CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
WELLBUTRIN SR 150MG TAB414732CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Racepinephrine 2.25% Inh414781CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
NOVOLOG414612ACDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Ramipril 2.5 MG414003CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Loperamide 1MG/7.5ML LIQ UD414378CDM250RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
CETIRIZINE HCL 10 MG TAB4140031CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Digoxin 0.125MG TAB414115CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
SINGULAIR 10MG TAB414184CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
CELEXA 20MG TAB414049CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Diphenhydramine 12.5mg/5ml 5ml cup414369CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
REMERON 15MG TAB414856CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
MILK OF MAGNESIA 30ML UD414386CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
DEPAKOTE 250MG TAB414066CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
NS 50CC IV BAG583621CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Oxymetazoline Nasal 30ML SPRAY414335CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
COUMADIN 2MG TAB414057CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
VERAPAMIL 120MG TAB414030CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
SULFAMETHTRIM Oral Susp 200mg/40mg/5ml414957CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Metformin 850 mg TAB414101CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
PROZAC 20 MG CAP414705CDM250RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Mupirocin 15GM CREAM414717CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
PROSCAR 5 MG TAB414172CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
MAALOX 30ML UD414385CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
CARMEX OINT414553CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Pravastatin 10mg2500026CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
NITRO BID 2% OINT UD414526CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
COUMADIN 5MG TAB414058CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
COUMADIN 1MG TAB414056CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
ZITHROMAX 200MG/5ML SUSP414401CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Hydrocortisone (ANUSOL) 25 MG SUPP414515CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
PROMETH/COD 5ML SYR414714CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Mag Sulfate 2ML2500070CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Sterile Water for Injection [50 mL]2500221CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Florastor 500mg2500238CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
LOPRESSOR 1MG/1ML 5ML AMP414424CDM250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
ZOVIRAX 800 MG CAP414330CDM250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
Propofol2500235CDM250RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
ZZHYDDROCORTISONE 100MG INJ3834CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
NS 250CC IV BAG611773CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
DITROPAN XL 5MG tab414076CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
DILTIAZEM 50MG/10ML 10ML VIAL414620CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
LYRICA CAPSULE 75 MG414964CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
DIPHENHYDRAMINE CREAM 2%4140014CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Lidocaine 5% Patch2500060CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Budesonide Inh Soln 0.5mg/2ml2500279CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Dicyclomine Hydrochloride333333CDM250RCboth8.55.15.10.6999999999 Percent of total billed charges6.120.72999999999 Percent of total billed charges6.220.732999999999 Percent of total billed charges7.230.85999999999 Percent of total billed charges7.650.9999999999 Percent of total billed charges5.840.687999999999 Percent of total billed charges5.17.65
FLOMAX 0.4MG CAP414096CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
MEGACE 40MG / 10 ML 10 ML susp414712CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
ZITHROMAX 250 MG TAB414227CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
PLAVIX 75MG TAB414163CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
NS 500CC IV BAG583645CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
LEXAPRO 10MG TAB414786CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
ZOLPIDEM 5MG TAB414645CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
PEDIALYTE SOL414800CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
WATER 30ML FOR INJ8279CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
DIOVAN 80MG TAB414073CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
CELEBREX 100MG CAP414050CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
RISPERDAL 1 MG414180CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
EFFEXOR XR 75MG cap414927CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
MACRODANTIN 50 MG CAP414133CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
Potassium Chloride 10 mEq/5 mL2500230CDM250RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
THEOPHYLINE 300MG TAB414205CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
Amoxicillin/Clavulanate Potassiu414015CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
DESITIN 57 GM OINTMENT414862CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
CIPRO 500 MG TAB414954CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
LAMOTRIGINE 100 MG tab414999CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
LEVAQUIN 250 MG IVPB2500051CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
Lamisil 1% Cream2500208CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
Nystatin Topical Powder2500210CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
NEO-SYNEPHRINE NASAL SPRAY 15 ml414341CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
NEO/POLYB/DEX O/O 3.5 GM OINT414537CDM250RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
LR 1000CC IV BAG571760CDM250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
DOXYCLYLINE 100MG cap414710CDM250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
FOLIC ACID 5MG/ML 10ML VIAL414780CDM250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
Fosphenytoin 50mg/ml 2ml2500203CDM250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
Magnesium Sulfate 4G/100mL2500223CDM250RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
CYMBALTA 30 MG CAP414907CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
LANTISEPTIC CREAM 0.5 FL OZ414844CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
BRETHINE 2.5 MG TAB414026CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
CLOTRIMAZOLE 1% CRM 45GM414550CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
Lidocaine 2% jelly2500031CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
METOPROLOL 5 MG/5ML AMP414425CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
NS 1/2 1000CC IV BAG611772CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
AVODART O.5MG CAP EA414774CDM250RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
Donepezil 10MG TAB414840CDM250RCboth137.87.80.6999999999 Percent of total billed charges9.360.72999999999 Percent of total billed charges9.520.732999999999 Percent of total billed charges11.050.85999999999 Percent of total billed charges11.70.9999999999 Percent of total billed charges8.930.687999999999 Percent of total billed charges7.811.7
NITROFURANTOIN 100MG CAP414134CDM250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
HYDROCODONE/APAP 2.5MG/108MG/5ML ORAL SO2500017CDM250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
HEPARIN 25000U/250ML 250ML IVPB414505CDM250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
CRESTOR 20 MG414305CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
PROTONIX 40MG TAB414834CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
BYSTOLIC 5 MG TABLET414929CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
HYPERTONIC SALINE 100MLIV46ACDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
Calmoseptine2500072CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
AQUAPHOR OINTMENT414301CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
HYPERTONIC SALINE 500ML IV BAGIV46CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
Dextrose 5% 1000 mL2500214CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
Epinephrine 10mg/10ml2500282CDM250RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
ABILIFY 10 MG414993CDM250RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
ROCURONIUM 100 MG2500194CDM250RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
Eliquis 5mg tab2500019CDM250RCboth1710.210.20.6999999999 Percent of total billed charges12.240.72999999999 Percent of total billed charges12.440.732999999999 Percent of total billed charges14.450.85999999999 Percent of total billed charges15.30.9999999999 Percent of total billed charges11.680.687999999999 Percent of total billed charges10.215.3
Esmolol Hcl 10mg/ml2500038CDM250RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
Potassium Chloride 20 mEq in 50 mL IVPB2500229CDM250RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
PULMICORT .5mg/2ML 2ML NEB414805CDM250RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
Di-Dak-Sol (Diluted Dakin's Sol 0.0125%)2500215CDM250RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
Polytrim Opth Soln2500219CDM250RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
Aquaphor Balm Stick2500285CDM250RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
Ketamine 100mg/ml 5ml vial2500041CDM250RCboth2012120.6999999999 Percent of total billed charges14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges13.740.687999999999 Percent of total billed charges1218
Etomidate 2mg/1ml414965CDM250RCboth2012120.6999999999 Percent of total billed charges14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges13.740.687999999999 Percent of total billed charges1218
DEXAMETHASON ELIXIR .5MG/5 ML414752CDM250RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
Enalaprilat 2.5mg/2ml vial2500036CDM250RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
VECURONIUM BROMIDE 10MG/10ml INJ414913CDM250RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
TROPICAMIDE2500061CDM250RCboth2213.213.20.6999999999 Percent of total billed charges15.840.72999999999 Percent of total billed charges16.10.732999999999 Percent of total billed charges18.70.85999999999 Percent of total billed charges19.80.9999999999 Percent of total billed charges15.110.687999999999 Percent of total billed charges13.219.8
FLUCONAZOLE 200MG (2MG/ML 100ML414992CDM250RCboth2213.213.20.6999999999 Percent of total billed charges15.840.72999999999 Percent of total billed charges16.10.732999999999 Percent of total billed charges18.70.85999999999 Percent of total billed charges19.80.9999999999 Percent of total billed charges15.110.687999999999 Percent of total billed charges13.219.8
Thera tears 0.5 fl oz2500241CDM250RCboth2213.213.20.6999999999 Percent of total billed charges15.840.72999999999 Percent of total billed charges16.10.732999999999 Percent of total billed charges18.70.85999999999 Percent of total billed charges19.80.9999999999 Percent of total billed charges15.110.687999999999 Percent of total billed charges13.219.8
TEARS EYE DROPS UD414543CDM250RCboth2414.414.40.6999999999 Percent of total billed charges17.280.72999999999 Percent of total billed charges17.570.732999999999 Percent of total billed charges20.40.85999999999 Percent of total billed charges21.60.9999999999 Percent of total billed charges16.490.687999999999 Percent of total billed charges14.421.6
DOPAMINE 400MG IV414504CDM250RCboth2414.414.40.6999999999 Percent of total billed charges17.280.72999999999 Percent of total billed charges17.570.732999999999 Percent of total billed charges20.40.85999999999 Percent of total billed charges21.60.9999999999 Percent of total billed charges16.490.687999999999 Percent of total billed charges14.421.6
Clindamycin 600 mg/ 5% Dex 50mL2500236CDM250RCboth24.814.8814.880.6999999999 Percent of total billed charges17.860.72999999999 Percent of total billed charges18.150.732999999999 Percent of total billed charges21.080.85999999999 Percent of total billed charges22.320.9999999999 Percent of total billed charges17.040.687999999999 Percent of total billed charges14.8822.32
Ezetimibe 10mg2500027CDM250RCboth2515150.6999999999 Percent of total billed charges180.72999999999 Percent of total billed charges18.30.732999999999 Percent of total billed charges21.250.85999999999 Percent of total billed charges22.50.9999999999 Percent of total billed charges17.180.687999999999 Percent of total billed charges1522.5
CALCIUM CHL 10% 10ML VIAL414433CDM250RCboth2515150.6999999999 Percent of total billed charges180.72999999999 Percent of total billed charges18.30.732999999999 Percent of total billed charges21.250.85999999999 Percent of total billed charges22.50.9999999999 Percent of total billed charges17.180.687999999999 Percent of total billed charges1522.5
SOD BICARD 8.4% 50ML SYG414569CDM250RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
LIDODERM 5% PATCH414967CDM250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
MEROPENEM INJ 1 GM2500045CDM250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
HYDROXYZINE 25 MG2500123CDM250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
MVI VIAL414615CDM250RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
BELLADONNA ALKALOIDS&PHENOBARB414359CDM250RCboth2816.816.80.6999999999 Percent of total billed charges20.160.72999999999 Percent of total billed charges20.50.732999999999 Percent of total billed charges23.80.85999999999 Percent of total billed charges25.20.9999999999 Percent of total billed charges19.240.687999999999 Percent of total billed charges16.825.2
LACRILUBE EYE OINTMENT414940CDM250RCboth2917.417.40.6999999999 Percent of total billed charges20.880.72999999999 Percent of total billed charges21.230.732999999999 Percent of total billed charges24.650.85999999999 Percent of total billed charges26.10.9999999999 Percent of total billed charges19.920.687999999999 Percent of total billed charges17.426.1
ROMAZICON 0.1MG/1ML 10ML VIAL414469CDM250RCboth2917.417.40.6999999999 Percent of total billed charges20.880.72999999999 Percent of total billed charges21.230.732999999999 Percent of total billed charges24.650.85999999999 Percent of total billed charges26.10.9999999999 Percent of total billed charges19.920.687999999999 Percent of total billed charges17.426.1
SILVER SULF 1% CRM 50GM414548CDM250RCboth3018180.6999999999 Percent of total billed charges21.60.72999999999 Percent of total billed charges21.960.732999999999 Percent of total billed charges25.50.85999999999 Percent of total billed charges270.9999999999 Percent of total billed charges20.610.687999999999 Percent of total billed charges1827
CATAPRES TTS 0.1MG PATCH (Clonidine)414810CDM250RCboth3018180.6999999999 Percent of total billed charges21.60.72999999999 Percent of total billed charges21.960.732999999999 Percent of total billed charges25.50.85999999999 Percent of total billed charges270.9999999999 Percent of total billed charges20.610.687999999999 Percent of total billed charges1827
TETRACAINE UD 15ML SOLN414544CDM250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
Levophed 1mg/1ml 4mg/4ml414978CDM250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
Acetaminophen 1,000 mg/100 mL IVPB2500217CDM250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
Uloric 80mg2500042CDM250RCboth3118.618.60.6999999999 Percent of total billed charges22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges21.30.687999999999 Percent of total billed charges18.627.9
ULORIC 40 MG TAB414998CDM250RCboth3219.219.20.6999999999 Percent of total billed charges23.040.72999999999 Percent of total billed charges23.420.732999999999 Percent of total billed charges27.20.85999999999 Percent of total billed charges28.80.9999999999 Percent of total billed charges21.980.687999999999 Percent of total billed charges19.228.8
XARELTO 10 MG TAB4140021CDM250RCboth3420.420.40.6999999999 Percent of total billed charges24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges23.360.687999999999 Percent of total billed charges20.430.6
LEVAQUIN 500 MG TAB414123CDM250RCboth3420.420.40.6999999999 Percent of total billed charges24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges23.360.687999999999 Percent of total billed charges20.430.6
Ondansetron oral soln 4mg/5ml2500289CDM250RCboth3420.420.40.6999999999 Percent of total billed charges24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges23.360.687999999999 Percent of total billed charges20.430.6
PROMETHAZINE 12.5 MG SUPP414623CDM250RCboth35.4121.2521.250.6999999999 Percent of total billed charges25.50.72999999999 Percent of total billed charges25.920.732999999999 Percent of total billed charges30.10.85999999999 Percent of total billed charges31.870.9999999999 Percent of total billed charges24.330.687999999999 Percent of total billed charges21.2531.87
NYSTATIN OINTMENT 15 GM414866CDM250RCboth3621.621.60.6999999999 Percent of total billed charges25.920.72999999999 Percent of total billed charges26.350.732999999999 Percent of total billed charges30.60.85999999999 Percent of total billed charges32.40.9999999999 Percent of total billed charges24.730.687999999999 Percent of total billed charges21.632.4
TAMIFLU 75MG CAP414823CDM250RCboth3722.222.20.6999999999 Percent of total billed charges26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges25.420.687999999999 Percent of total billed charges22.233.3
Propofol 10mg/ml2500198CDM250RCboth3722.222.20.6999999999 Percent of total billed charges26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges25.420.687999999999 Percent of total billed charges22.233.3
Hydralazine 20mg/ml2500006CDM250RCboth3923.423.40.6999999999 Percent of total billed charges28.080.72999999999 Percent of total billed charges28.550.732999999999 Percent of total billed charges33.150.85999999999 Percent of total billed charges35.10.9999999999 Percent of total billed charges26.790.687999999999 Percent of total billed charges23.435.1
DEXTROSE 10% 250ML IV BAG414843CDM250RCboth3923.423.40.6999999999 Percent of total billed charges28.080.72999999999 Percent of total billed charges28.550.732999999999 Percent of total billed charges33.150.85999999999 Percent of total billed charges35.10.9999999999 Percent of total billed charges26.790.687999999999 Percent of total billed charges23.435.1
FENTANYL 12 MCG PATCH4140030CDM250RCboth4124.624.60.6999999999 Percent of total billed charges29.520.72999999999 Percent of total billed charges30.010.732999999999 Percent of total billed charges34.850.85999999999 Percent of total billed charges36.90.9999999999 Percent of total billed charges28.170.687999999999 Percent of total billed charges24.636.9
NEO POLYB DEX OPTH 5 ML SUSPENSION414912CDM250RCboth4124.624.60.6999999999 Percent of total billed charges29.520.72999999999 Percent of total billed charges30.010.732999999999 Percent of total billed charges34.850.85999999999 Percent of total billed charges36.90.9999999999 Percent of total billed charges28.170.687999999999 Percent of total billed charges24.636.9
DURAGESIC 25MCG PATCH414681CDM250RCboth4325.825.80.6999999999 Percent of total billed charges30.960.72999999999 Percent of total billed charges31.480.732999999999 Percent of total billed charges36.550.85999999999 Percent of total billed charges38.70.9999999999 Percent of total billed charges29.540.687999999999 Percent of total billed charges25.838.7
ERYTHROMYCIN 0.5% OINT 3.5GM414540CDM250RCboth4527270.6999999999 Percent of total billed charges32.40.72999999999 Percent of total billed charges32.940.732999999999 Percent of total billed charges38.250.85999999999 Percent of total billed charges40.50.9999999999 Percent of total billed charges30.920.687999999999 Percent of total billed charges2740.5
VERAPAMIL 2.5MG/ML 2 ML VIAL414423CDM250RCboth4627.627.60.6999999999 Percent of total billed charges33.120.72999999999 Percent of total billed charges33.670.732999999999 Percent of total billed charges39.10.85999999999 Percent of total billed charges41.40.9999999999 Percent of total billed charges31.60.687999999999 Percent of total billed charges27.641.4
TRANEXAMIC ACID 100MG/ML 10 ML4140027CDM250RCboth4728.228.20.6999999999 Percent of total billed charges33.840.72999999999 Percent of total billed charges34.40.732999999999 Percent of total billed charges39.950.85999999999 Percent of total billed charges42.30.9999999999 Percent of total billed charges32.290.687999999999 Percent of total billed charges28.242.3
NITROGLYCERIN 200MCG/1ML 250ML BTL414419CDM250RCboth4728.228.20.6999999999 Percent of total billed charges33.840.72999999999 Percent of total billed charges34.40.732999999999 Percent of total billed charges39.950.85999999999 Percent of total billed charges42.30.9999999999 Percent of total billed charges32.290.687999999999 Percent of total billed charges28.242.3
D5 1/2NS 20MG POTASIUM PREMIX414725CDM250RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
Fluzone Quadrivalent2500280CDM250RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
Potassium Chl. 10mEq/50ml4143334CDM250RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
Labetalol HCL 5mg/ml 20 ml vail414481CDM250RCboth5231.231.20.6999999999 Percent of total billed charges37.440.72999999999 Percent of total billed charges38.060.732999999999 Percent of total billed charges44.20.85999999999 Percent of total billed charges46.80.9999999999 Percent of total billed charges35.720.687999999999 Percent of total billed charges31.246.8
DEXFERRUM 50MG/1ML 1ML VIAL414606CDM250RCboth5331.831.80.6999999999 Percent of total billed charges38.160.72999999999 Percent of total billed charges38.80.732999999999 Percent of total billed charges45.050.85999999999 Percent of total billed charges47.70.9999999999 Percent of total billed charges36.410.687999999999 Percent of total billed charges31.847.7
DURAGESIC 50MCG PATCH414682CDM250RCboth5432.432.40.6999999999 Percent of total billed charges38.880.72999999999 Percent of total billed charges39.530.732999999999 Percent of total billed charges45.90.85999999999 Percent of total billed charges48.60.9999999999 Percent of total billed charges37.10.687999999999 Percent of total billed charges32.448.6
Activated Charcoal 50GM SUSP414696CDM250RCboth5633.633.60.6999999999 Percent of total billed charges40.320.72999999999 Percent of total billed charges40.990.732999999999 Percent of total billed charges47.60.85999999999 Percent of total billed charges50.40.9999999999 Percent of total billed charges38.470.687999999999 Percent of total billed charges33.650.4
POTASSIUM CHL UD 40meq/30 mlML SOLN414381CDM250RCboth5834.834.80.6999999999 Percent of total billed charges41.760.72999999999 Percent of total billed charges42.460.732999999999 Percent of total billed charges49.30.85999999999 Percent of total billed charges52.20.9999999999 Percent of total billed charges39.850.687999999999 Percent of total billed charges34.852.2
INJECTION IM/SQ30496372CDM250RCboth5834.834.80.6999999999 Percent of total billed charges41.760.72999999999 Percent of total billed charges42.460.732999999999 Percent of total billed charges49.30.85999999999 Percent of total billed charges52.20.9999999999 Percent of total billed charges39.850.687999999999 Percent of total billed charges34.852.2
DOXYCYCLINE 100MG VIAL414872CDM250RCboth6237.237.20.6999999999 Percent of total billed charges44.640.72999999999 Percent of total billed charges45.380.732999999999 Percent of total billed charges52.70.85999999999 Percent of total billed charges55.80.9999999999 Percent of total billed charges42.590.687999999999 Percent of total billed charges37.255.8
ZZMONISTAT CREME 7 KIT2432CDM250RCboth6337.837.80.6999999999 Percent of total billed charges45.360.72999999999 Percent of total billed charges46.120.732999999999 Percent of total billed charges53.550.85999999999 Percent of total billed charges56.70.9999999999 Percent of total billed charges43.280.687999999999 Percent of total billed charges37.856.7
SODIUM POLYSTYRENE 15GM SUSP414398CDM250RCboth6337.837.80.6999999999 Percent of total billed charges45.360.72999999999 Percent of total billed charges46.120.732999999999 Percent of total billed charges53.550.85999999999 Percent of total billed charges56.70.9999999999 Percent of total billed charges43.280.687999999999 Percent of total billed charges37.856.7
Norepinephrine 4mg/250ml2500286CDM250RCboth6438.438.40.6999999999 Percent of total billed charges46.080.72999999999 Percent of total billed charges46.850.732999999999 Percent of total billed charges54.40.85999999999 Percent of total billed charges57.60.9999999999 Percent of total billed charges43.970.687999999999 Percent of total billed charges38.457.6
DEXTROSE 5% 500ML IV526160CDM250RCboth6740.240.20.6999999999 Percent of total billed charges48.240.72999999999 Percent of total billed charges49.040.732999999999 Percent of total billed charges56.950.85999999999 Percent of total billed charges60.30.9999999999 Percent of total billed charges46.030.687999999999 Percent of total billed charges40.260.3
Humalog drip2500050CDM250RCboth6740.240.20.6999999999 Percent of total billed charges48.240.72999999999 Percent of total billed charges49.040.732999999999 Percent of total billed charges56.950.85999999999 Percent of total billed charges60.30.9999999999 Percent of total billed charges46.030.687999999999 Percent of total billed charges40.260.3
D5 1/2 NS 1000CC531745CDM250RCboth6941.441.40.6999999999 Percent of total billed charges49.680.72999999999 Percent of total billed charges50.510.732999999999 Percent of total billed charges58.650.85999999999 Percent of total billed charges62.10.9999999999 Percent of total billed charges47.40.687999999999 Percent of total billed charges41.462.1
TOBRAMYCIN 0.3% O/S 5ML414533CDM250RCboth6941.441.40.6999999999 Percent of total billed charges49.680.72999999999 Percent of total billed charges50.510.732999999999 Percent of total billed charges58.650.85999999999 Percent of total billed charges62.10.9999999999 Percent of total billed charges47.40.687999999999 Percent of total billed charges41.462.1
Daptomycin 500mg vial2500287CDM250RCboth7545450.6999999999 Percent of total billed charges540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges51.530.687999999999 Percent of total billed charges4567.5
VALPROATE 500MG/5ML 5ML VIAL414723CDM250RCboth76.1245.6745.670.6999999999 Percent of total billed charges54.810.72999999999 Percent of total billed charges55.720.732999999999 Percent of total billed charges64.70.85999999999 Percent of total billed charges68.510.9999999999 Percent of total billed charges52.290.687999999999 Percent of total billed charges45.6768.51
D50.2% NS 1000ML IV BAG531265CDM250RCboth7947.447.40.6999999999 Percent of total billed charges56.880.72999999999 Percent of total billed charges57.830.732999999999 Percent of total billed charges67.150.85999999999 Percent of total billed charges71.10.9999999999 Percent of total billed charges54.270.687999999999 Percent of total billed charges47.471.1
Novolog insulin pen2500206CDM250RCboth8148.648.60.6999999999 Percent of total billed charges58.320.72999999999 Percent of total billed charges59.290.732999999999 Percent of total billed charges68.850.85999999999 Percent of total billed charges72.90.9999999999 Percent of total billed charges55.650.687999999999 Percent of total billed charges48.672.9
DTap vaccine2500293CDM250RCboth8249.249.20.6999999999 Percent of total billed charges59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges56.330.687999999999 Percent of total billed charges49.273.8
FLUOCUNINUDE 0.05% CRM 30GM414520CDM250RCboth9355.855.80.6999999999 Percent of total billed charges66.960.72999999999 Percent of total billed charges68.080.732999999999 Percent of total billed charges79.050.85999999999 Percent of total billed charges83.70.9999999999 Percent of total billed charges63.890.687999999999 Percent of total billed charges55.883.7
EYE STREAM SOL 4 OZ414541CDM250RCboth9758.258.20.6999999999 Percent of total billed charges69.840.72999999999 Percent of total billed charges710.732999999999 Percent of total billed charges82.450.85999999999 Percent of total billed charges87.30.9999999999 Percent of total billed charges66.640.687999999999 Percent of total billed charges58.287.3
Bentyl 20mg/2ml (Dicyclomine HCL)4143333CDM250RCboth10060600.6999999999 Percent of total billed charges720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges68.70.687999999999 Percent of total billed charges6090
Propofol 1000mg/100ml2500239CDM250RCboth10864.864.80.6999999999 Percent of total billed charges77.760.72999999999 Percent of total billed charges79.060.732999999999 Percent of total billed charges91.80.85999999999 Percent of total billed charges97.20.9999999999 Percent of total billed charges74.20.687999999999 Percent of total billed charges64.897.2
CETACAINE SPRAY414368CDM250RCboth11166.666.60.6999999999 Percent of total billed charges79.920.72999999999 Percent of total billed charges81.250.732999999999 Percent of total billed charges94.350.85999999999 Percent of total billed charges99.90.9999999999 Percent of total billed charges76.260.687999999999 Percent of total billed charges66.699.9
ATROPINE SULFATE OPTH SOL1% 5M414901CDM250RCboth11468.468.40.6999999999 Percent of total billed charges82.080.72999999999 Percent of total billed charges83.450.732999999999 Percent of total billed charges96.90.85999999999 Percent of total billed charges102.60.9999999999 Percent of total billed charges78.320.687999999999 Percent of total billed charges68.4102.6
DURAGESIC 100MG PATCH414683CDM250RCboth12072720.6999999999 Percent of total billed charges86.40.72999999999 Percent of total billed charges87.840.732999999999 Percent of total billed charges1020.85999999999 Percent of total billed charges1080.9999999999 Percent of total billed charges82.440.687999999999 Percent of total billed charges72108
VIT K 10MG AMP414430CDM250RCboth12172.672.60.6999999999 Percent of total billed charges87.120.72999999999 Percent of total billed charges88.570.732999999999 Percent of total billed charges102.850.85999999999 Percent of total billed charges108.90.9999999999 Percent of total billed charges83.130.687999999999 Percent of total billed charges72.6108.9
LOVENOX 100MG SYG414791CDM250RCboth13782.282.20.6999999999 Percent of total billed charges98.640.72999999999 Percent of total billed charges100.280.732999999999 Percent of total billed charges116.450.85999999999 Percent of total billed charges123.30.9999999999 Percent of total billed charges94.120.687999999999 Percent of total billed charges82.2123.3
Lantus insulin pen 100 units/ml 3ml2500200CDM250RCboth15693.693.60.6999999999 Percent of total billed charges112.320.72999999999 Percent of total billed charges114.190.732999999999 Percent of total billed charges132.60.85999999999 Percent of total billed charges140.40.9999999999 Percent of total billed charges107.170.687999999999 Percent of total billed charges93.6140.4
PROCTOSOL 2 CRM414754CDM250RCboth15693.693.60.6999999999 Percent of total billed charges112.320.72999999999 Percent of total billed charges114.190.732999999999 Percent of total billed charges132.60.85999999999 Percent of total billed charges140.40.9999999999 Percent of total billed charges107.170.687999999999 Percent of total billed charges93.6140.4
Truvada tab 200/300 mg2500197CDM250RCboth1701021020.6999999999 Percent of total billed charges122.40.72999999999 Percent of total billed charges124.440.732999999999 Percent of total billed charges144.50.85999999999 Percent of total billed charges1530.9999999999 Percent of total billed charges116.790.687999999999 Percent of total billed charges102153
ZAROXOLYN 2.5 MG TAB414226CDM250RCboth2151291290.6999999999 Percent of total billed charges154.80.72999999999 Percent of total billed charges157.380.732999999999 Percent of total billed charges182.750.85999999999 Percent of total billed charges193.50.9999999999 Percent of total billed charges147.710.687999999999 Percent of total billed charges129193.5
Olumiant 2mg tab2500207CDM250RCboth223133.8133.80.6999999999 Percent of total billed charges160.560.72999999999 Percent of total billed charges163.240.732999999999 Percent of total billed charges189.550.85999999999 Percent of total billed charges200.70.9999999999 Percent of total billed charges153.20.687999999999 Percent of total billed charges133.8200.7
Neo PolyB w/HC Otic (Corticosporin) 10ML414565CDM250RCboth248148.8148.80.6999999999 Percent of total billed charges178.560.72999999999 Percent of total billed charges181.540.732999999999 Percent of total billed charges210.80.85999999999 Percent of total billed charges223.20.9999999999 Percent of total billed charges170.380.687999999999 Percent of total billed charges148.8223.2
Atropine Sulfate Inj 0.5mg/5ml2500281CDM250RCboth286171.6171.60.6999999999 Percent of total billed charges205.920.72999999999 Percent of total billed charges209.350.732999999999 Percent of total billed charges243.10.85999999999 Percent of total billed charges257.40.9999999999 Percent of total billed charges196.480.687999999999 Percent of total billed charges171.6257.4
FOSPHENYTOIN SODIUM 500MG/10ML4140019CDM250RCboth294176.4176.40.6999999999 Percent of total billed charges211.680.72999999999 Percent of total billed charges215.210.732999999999 Percent of total billed charges249.90.85999999999 Percent of total billed charges264.60.9999999999 Percent of total billed charges201.980.687999999999 Percent of total billed charges176.4264.6
Cardene 20mg/200ml premix inj bag2500033CDM250RCboth3001801800.6999999999 Percent of total billed charges2160.72999999999 Percent of total billed charges219.60.732999999999 Percent of total billed charges2550.85999999999 Percent of total billed charges2700.9999999999 Percent of total billed charges206.10.687999999999 Percent of total billed charges180270
VASOPRESSIN414906CDM250RCboth307184.2184.20.6999999999 Percent of total billed charges221.040.72999999999 Percent of total billed charges224.720.732999999999 Percent of total billed charges260.950.85999999999 Percent of total billed charges276.30.9999999999 Percent of total billed charges210.910.687999999999 Percent of total billed charges184.2276.3
ADVAIR DISKUS 250/50414963CDM250RCboth412247.2247.20.6999999999 Percent of total billed charges296.640.72999999999 Percent of total billed charges301.580.732999999999 Percent of total billed charges350.20.85999999999 Percent of total billed charges370.80.9999999999 Percent of total billed charges283.040.687999999999 Percent of total billed charges247.2370.8
GLUCAGON 1MG 1ML KIT414614CDM250RCboth502301.2301.20.6999999999 Percent of total billed charges361.440.72999999999 Percent of total billed charges367.460.732999999999 Percent of total billed charges426.70.85999999999 Percent of total billed charges451.80.9999999999 Percent of total billed charges344.870.687999999999 Percent of total billed charges301.2451.8
Remdesivir **IVPB** 100MG/250ML2500277CDM250RCboth624374.4374.40.6999999999 Percent of total billed charges449.280.72999999999 Percent of total billed charges456.770.732999999999 Percent of total billed charges530.40.85999999999 Percent of total billed charges561.60.9999999999 Percent of total billed charges428.690.687999999999 Percent of total billed charges374.4561.6
Remdesivir 100mg/20ml2500204CDM250RCboth1591954.6954.60.6999999999 Percent of total billed charges1145.520.72999999999 Percent of total billed charges1164.610.732999999999 Percent of total billed charges1352.350.85999999999 Percent of total billed charges1431.90.9999999999 Percent of total billed charges1093.020.687999999999 Percent of total billed charges954.61431.9
Epogen 40,000 units2500232CDM250RCboth17341040.41040.40.6999999999 Percent of total billed charges1248.480.72999999999 Percent of total billed charges1269.290.732999999999 Percent of total billed charges1473.90.85999999999 Percent of total billed charges1560.60.9999999999 Percent of total billed charges1191.260.687999999999 Percent of total billed charges1040.41560.6
Injectafer(Ferric Carboxymaltose) 750mg2500233CDM250RCboth27841670.41670.40.6999999999 Percent of total billed charges2004.480.72999999999 Percent of total billed charges2037.890.732999999999 Percent of total billed charges2366.40.85999999999 Percent of total billed charges2505.60.9999999999 Percent of total billed charges1912.610.687999999999 Percent of total billed charges1670.42505.6
Anavip (1 vial)2500227CDM250RCboth3605216321630.6999999999 Percent of total billed charges2595.60.72999999999 Percent of total billed charges2638.860.732999999999 Percent of total billed charges3064.250.85999999999 Percent of total billed charges3244.50.9999999999 Percent of total billed charges2476.640.687999999999 Percent of total billed charges21633244.5
Andexxa2500292CDM250RCboth2000012000120000.6999999999 Percent of total billed charges144000.72999999999 Percent of total billed charges146400.732999999999 Percent of total billed charges170000.85999999999 Percent of total billed charges180000.9999999999 Percent of total billed charges137400.687999999999 Percent of total billed charges1200018000
FLUTICASONE NASAL 50MCG2500002CDM250RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
Vitamin K 1mg/.5ml2500007CDM250RCboth10.26.126.120.6999999999 Percent of total billed charges7.340.72999999999 Percent of total billed charges7.470.732999999999 Percent of total billed charges8.670.85999999999 Percent of total billed charges9.180.9999999999 Percent of total billed charges7.010.687999999999 Percent of total billed charges6.129.18
Dextrose 100ml IV bag2500025CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
CLINDAMYCIN (Cleocin) 600 MG/4 mL2500048CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
ZYRTEC HCL Peds Liquid2500071CDM250RCboth22.0413.2213.220.6999999999 Percent of total billed charges15.870.72999999999 Percent of total billed charges16.130.732999999999 Percent of total billed charges18.730.85999999999 Percent of total billed charges19.840.9999999999 Percent of total billed charges15.140.687999999999 Percent of total billed charges13.2219.84
Daptomycin 350 mg/vial2500226CDM250RCboth5432.432.40.6999999999 Percent of total billed charges38.880.72999999999 Percent of total billed charges39.530.732999999999 Percent of total billed charges45.90.85999999999 Percent of total billed charges48.60.9999999999 Percent of total billed charges37.10.687999999999 Percent of total billed charges32.448.6
Dopamine HCL 800mg/500ml2500296CDM250RCboth3521210.6999999999 Percent of total billed charges25.20.72999999999 Percent of total billed charges25.620.732999999999 Percent of total billed charges29.750.85999999999 Percent of total billed charges31.50.9999999999 Percent of total billed charges24.050.687999999999 Percent of total billed charges2131.5
Vancomycin 125mg cap2500297CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Seroquel (Quetiapine) 25mg2500298CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Ciprofloxacin ophthalmic soln2500299CDM250RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
NS 0.9% 100 ml2500300CDM250RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Metoprolol ER Succ 100mg2500301CDM250RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
COLCHICINE .6 MG TAB4140011CDM250RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
MARCAINE 0.25% 10ML INJ414409CDM250RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
CLINDAMYCIN (CLEOCIN) 300MG/2ML414486CDM250RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
AMPICILLIN 1GM VIAL414483CDMJ0290CPT251RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
LIDOCAINE 2% 100 MG SYG414420CDMJ2001CPT251RCboth0.01
ALBUTEROL INHALER414334CDMJ7613CPT251RCboth10361.861.80.6999999999 Percent of total billed charges74.160.72999999999 Percent of total billed charges75.40.732999999999 Percent of total billed charges87.550.85999999999 Percent of total billed charges92.70.9999999999 Percent of total billed charges70.760.687999999999 Percent of total billed charges61.892.7
SULFAMETH/TRI 10ML IM/IV414761CDMS0039CPT251RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
CHOLESTYRAMINE SUSP414751CDM251RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
TRIAMCINOLONE 0.1%GM CRM414523CDM251RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
ZZAMOXICILLIN 250MG/5 150ML2592CDM251RCboth4527270.6999999999 Percent of total billed charges32.40.72999999999 Percent of total billed charges32.940.732999999999 Percent of total billed charges38.250.85999999999 Percent of total billed charges40.50.9999999999 Percent of total billed charges30.920.687999999999 Percent of total billed charges2740.5
CARBIDOPA LEVODOPA 25/100MG TA414182CDM251RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
SEROQUEL 100MG414971CDM252RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
B-12 1000MCG tablet414436CDM252RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Sodium Bicarb 4.2% VIAL414470CDM252RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
PITOCIN 1ML AMP 10 UNT414603CDM252RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
INSTA GLUCOSE GEL 31GM414555CDM252RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
SILVER NITRATE STICKER40CDM257RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
MINERAL OIL 30CC414395CDM257RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
INTRO IV CATH30436000CDM36000CPT260RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
IV HYDRATION INTIAL UP TO 1HR30790760CDM96360CPT260RCboth11267.267.20.6999999999 Percent of total billed charges80.640.72999999999 Percent of total billed charges81.980.732999999999 Percent of total billed charges95.20.85999999999 Percent of total billed charges100.80.9999999999 Percent of total billed charges76.940.687999999999 Percent of total billed charges67.2100.8
IV HYDRATION INTIAL UP TO 1HR30490760CDM96360CPT260RCboth11267.267.20.6999999999 Percent of total billed charges80.640.72999999999 Percent of total billed charges81.980.732999999999 Percent of total billed charges95.20.85999999999 Percent of total billed charges100.80.9999999999 Percent of total billed charges76.940.687999999999 Percent of total billed charges67.2100.8
IV HYDRATION EACH ADD HOUR30490761CDM96361CPT260RCboth4024240.6999999999 Percent of total billed charges28.80.72999999999 Percent of total billed charges29.280.732999999999 Percent of total billed charges340.85999999999 Percent of total billed charges360.9999999999 Percent of total billed charges27.480.687999999999 Percent of total billed charges2436
IV HYDRATION EACH HOUR30790761CDM96361CPT260RCboth4024240.6999999999 Percent of total billed charges28.80.72999999999 Percent of total billed charges29.280.732999999999 Percent of total billed charges340.85999999999 Percent of total billed charges360.9999999999 Percent of total billed charges27.480.687999999999 Percent of total billed charges2436
IV INFUSION INTIAL UPTO 1 HR30790765CDM96365CPT260RCboth2101261260.6999999999 Percent of total billed charges151.20.72999999999 Percent of total billed charges153.720.732999999999 Percent of total billed charges178.50.85999999999 Percent of total billed charges1890.9999999999 Percent of total billed charges144.270.687999999999 Percent of total billed charges126189
IV INFUSION INTIAL UPTO 1HR30490765CDM96365CPT260RCboth2101261260.6999999999 Percent of total billed charges151.20.72999999999 Percent of total billed charges153.720.732999999999 Percent of total billed charges178.50.85999999999 Percent of total billed charges1890.9999999999 Percent of total billed charges144.270.687999999999 Percent of total billed charges126189
IV INFUSION EA ADD HOUR30790766CDM96366CPT260RCboth6438.438.40.6999999999 Percent of total billed charges46.080.72999999999 Percent of total billed charges46.850.732999999999 Percent of total billed charges54.40.85999999999 Percent of total billed charges57.60.9999999999 Percent of total billed charges43.970.687999999999 Percent of total billed charges38.457.6
INFUSION EACH ADD HOUR30490766CDM96366CPT260RCboth6438.438.40.6999999999 Percent of total billed charges46.080.72999999999 Percent of total billed charges46.850.732999999999 Percent of total billed charges54.40.85999999999 Percent of total billed charges57.60.9999999999 Percent of total billed charges43.970.687999999999 Percent of total billed charges38.457.6
IV INFUSION SEQUEN UPTO 1 HR30790767CDM96367CPT260RCboth9255.255.20.6999999999 Percent of total billed charges66.240.72999999999 Percent of total billed charges67.340.732999999999 Percent of total billed charges78.20.85999999999 Percent of total billed charges82.80.9999999999 Percent of total billed charges63.20.687999999999 Percent of total billed charges55.282.8
INFUSION ADD SEQUT UP TO 1 HR30490767CDM96367CPT260RCboth9255.255.20.6999999999 Percent of total billed charges66.240.72999999999 Percent of total billed charges67.340.732999999999 Percent of total billed charges78.20.85999999999 Percent of total billed charges82.80.9999999999 Percent of total billed charges63.20.687999999999 Percent of total billed charges55.282.8
IV INFUSTION CONC REPORT ONCE30790768CDM96368CPT260RCboth6237.237.20.6999999999 Percent of total billed charges44.640.72999999999 Percent of total billed charges45.380.732999999999 Percent of total billed charges52.70.85999999999 Percent of total billed charges55.80.9999999999 Percent of total billed charges42.590.687999999999 Percent of total billed charges37.255.8
IV INFUSION CONC INF ONCE30490768CDM96368CPT260RCboth6237.237.20.6999999999 Percent of total billed charges44.640.72999999999 Percent of total billed charges45.380.732999999999 Percent of total billed charges52.70.85999999999 Percent of total billed charges55.80.9999999999 Percent of total billed charges42.590.687999999999 Percent of total billed charges37.255.8
IV PUSH INTIAL OR SINGLE DRUG30490774CDM96374CPT260RCboth11468.468.40.6999999999 Percent of total billed charges82.080.72999999999 Percent of total billed charges83.450.732999999999 Percent of total billed charges96.90.85999999999 Percent of total billed charges102.60.9999999999 Percent of total billed charges78.320.687999999999 Percent of total billed charges68.4102.6
IV PUSH SINGLE OR INTIAL DRUG30790774CDM96374CPT260RCboth11468.468.40.6999999999 Percent of total billed charges82.080.72999999999 Percent of total billed charges83.450.732999999999 Percent of total billed charges96.90.85999999999 Percent of total billed charges102.60.9999999999 Percent of total billed charges78.320.687999999999 Percent of total billed charges68.4102.6
IV PUSH EACH ADD FOR NEW DRUG30490775CDM96375CPT260RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
IV PUSH EACH ADD SEQU SAME RX30790776CDM96375CPT260RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
IV PUSH EACH ADD SEQU IV30790775CDM96375CPT260RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
IV PUSH SAME MED(31 MIN APART)45096376CDM96376CPT260RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
IV PUSH EACH ADDTL SAME RX30490776CDM96376CPT260RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
PORT FLUSH30796523CDM96523CPT260RCboth4627.627.60.6999999999 Percent of total billed charges33.120.72999999999 Percent of total billed charges33.670.732999999999 Percent of total billed charges39.10.85999999999 Percent of total billed charges41.40.9999999999 Percent of total billed charges31.60.687999999999 Percent of total billed charges27.641.4
Regen-Cov infusion260001CDMM0243CPT260RCboth867520.2520.20.6999999999 Percent of total billed charges624.240.72999999999 Percent of total billed charges634.640.732999999999 Percent of total billed charges736.950.85999999999 Percent of total billed charges780.30.9999999999 Percent of total billed charges595.630.687999999999 Percent of total billed charges520.2780.3
NS 1000CC IV BAG583665CDM260RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
FLAGYL 500MG IVPB PREMIX414498CDM260RCboth3018180.6999999999 Percent of total billed charges21.60.72999999999 Percent of total billed charges21.960.732999999999 Percent of total billed charges25.50.85999999999 Percent of total billed charges270.9999999999 Percent of total billed charges20.610.687999999999 Percent of total billed charges1827
Sexual Assault kit99070CDM99070CPT270RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
COLLAR CERVICAL ANY SIZEOR17CDM270RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
SKIN STAPLERST6CDM270RCboth0.01
IV PRIMARY SETIV6CDM270RCboth0.01
SALEM SUMP TUBECA24CDM270RCboth0.01
IV ANGIO CATH INTERLINKIV2CDM270RCboth0.01
IV EXTENSIONIV1CDM270RCboth0.01
TELFA pad 3x427025710CDM270RCboth0.01
NEBULIZER1R27CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
STERILE 4X4 PER 10PKDR15CDM270RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Povidone Iodine PVP swab2700039CDM270RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TELFA pad 3x827025711CDM270RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
Swabstick w/ compound benzoin2700003CDM270RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Dressing, Oprifoam Non Adheisve 4x42700017CDM270RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
Sterile Saline2700038CDM270RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
EXUDERM Satin Hydrocolloid dressing 2x22705422CDM270RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
WATER STERILEA584785CDM270RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
STERI STRIPS 1-10ST1CDM270RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Stratasorb waterproof 4x42700026CDM270RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
ALGINATE Dressing 2"x2"270A6197CDM270RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
SwiftWrap 4x5HH23CDM270RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
Petrolatum Dressing 3 x 92700041CDM270RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Xeroform Petrolatum Dressing 5"x9"27025119CDM270RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
Swiftwrap 3x5R8CDM270RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
50 ML STERILE WATER270003CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
ALGINATE WOUND DRESSING270A6196CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
CATH SUCTION 18FRCA3CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
Stratasorb waterproof 6x62703066CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
SwiftWrap 6x52707700CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
DRESSING TEGADERM 2X2HH10CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
CONFORMING STERILE BANDAGE308A6445CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
IRRIGATION TRAYCA22CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Stratasorb waterproof 4x102703067CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
EXUDERM Satin Hydrocolloid dressing 4x42705423CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
ALGINATE Dressing 4"x4"270A6198CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Optifoam foam dressing 3x3270A6214CDM270RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
Dressing, Optifoam thin 4x42700018CDM270RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
Stratasorb waterproof 4x142703068CDM270RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
IV START KITIV8CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
COFLEX/COBAN 3-5 INDR41CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
COFLEX/COBAN LESS THAN 3 INDR40CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
ENDOTRACHEAL TUBE HOLDERER33CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
DRESSING ADAPTIC 3X8 EADR37CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Stratasorb waterproof 6x7.52703069CDM270RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
Leg bags with twist valve2700033CDM270RCboth95.45.40.6999999999 Percent of total billed charges6.480.72999999999 Percent of total billed charges6.590.732999999999 Percent of total billed charges7.650.85999999999 Percent of total billed charges8.10.9999999999 Percent of total billed charges6.180.687999999999 Percent of total billed charges5.48.1
Dressing, Maxorb Extra Ag, Silver Alg 2x2700014CDM270RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
CATH SECUREMI45CDM270RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
ENDOTRACHEAL TUBE INTRO 15FRER42CDM270RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
Cleanser, wound skintegrity2700021CDM270RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
Carra Klenz wound cleaner2700043CDM270RCboth127.27.20.6999999999 Percent of total billed charges8.640.72999999999 Percent of total billed charges8.780.732999999999 Percent of total billed charges10.20.85999999999 Percent of total billed charges10.80.9999999999 Percent of total billed charges8.240.687999999999 Percent of total billed charges7.210.8
Chlora prep FREPP applicator2700029CDM270RCboth137.87.80.6999999999 Percent of total billed charges9.360.72999999999 Percent of total billed charges9.520.732999999999 Percent of total billed charges11.050.85999999999 Percent of total billed charges11.70.9999999999 Percent of total billed charges8.930.687999999999 Percent of total billed charges7.811.7
EXUDERM Satin Hydrocolloid dressing 6x62705424CDM270RCboth137.87.80.6999999999 Percent of total billed charges9.360.72999999999 Percent of total billed charges9.520.732999999999 Percent of total billed charges11.050.85999999999 Percent of total billed charges11.70.9999999999 Percent of total billed charges8.930.687999999999 Percent of total billed charges7.811.7
EXUDERM Satin Hydrocolloid dressing 4x3.2705426CDM270RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
Optifoam foam dressing 6x6270A6213CDM270RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
Skintegrity wound cleansers2700050CDM270RCboth15990.6999999999 Percent of total billed charges10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges10.310.687999999999 Percent of total billed charges913.5
Dressing, Maxorb Extra Ag, Silver 6x62700016CDM270RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
OXYGEN PER HOUROX1CDM270RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
Dressing, Maxorb Extra Ag, Algnte 4x4.752700015CDM270RCboth1710.210.20.6999999999 Percent of total billed charges12.240.72999999999 Percent of total billed charges12.440.732999999999 Percent of total billed charges14.450.85999999999 Percent of total billed charges15.30.9999999999 Percent of total billed charges11.680.687999999999 Percent of total billed charges10.215.3
DRESSING OPTIFOAM W/ BORDER270A6212CDM270RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
Ultracell single use ear wick2700044CDM270RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
ALGINATE Dressing 6"x6"270A6199CDM270RCboth1810.810.80.6999999999 Percent of total billed charges12.960.72999999999 Percent of total billed charges13.180.732999999999 Percent of total billed charges15.30.85999999999 Percent of total billed charges16.20.9999999999 Percent of total billed charges12.370.687999999999 Percent of total billed charges10.816.2
DuoDerm Dressing 6"x6"2705444CDM270RCboth2012120.6999999999 Percent of total billed charges14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges13.740.687999999999 Percent of total billed charges1218
Splint, soft shell or SAM, any sizeOR37CDM270RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
BURETROLIV43CDM270RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
HALO CHEST WOUND SEALS3071000CDM270RCboth2213.213.20.6999999999 Percent of total billed charges15.840.72999999999 Percent of total billed charges16.10.732999999999 Percent of total billed charges18.70.85999999999 Percent of total billed charges19.80.9999999999 Percent of total billed charges15.110.687999999999 Percent of total billed charges13.219.8
Med Fix Dressing retention tape2700031CDM270RCboth2313.813.80.6999999999 Percent of total billed charges16.560.72999999999 Percent of total billed charges16.840.732999999999 Percent of total billed charges19.550.85999999999 Percent of total billed charges20.70.9999999999 Percent of total billed charges15.80.687999999999 Percent of total billed charges13.820.7
EXUDERM Satin Hydrocolloid dressing 8x82705425CDM270RCboth2313.813.80.6999999999 Percent of total billed charges16.560.72999999999 Percent of total billed charges16.840.732999999999 Percent of total billed charges19.550.85999999999 Percent of total billed charges20.70.9999999999 Percent of total billed charges15.80.687999999999 Percent of total billed charges13.820.7
Vashe wound solution2700042CDM270RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
ALGINATE Wound & Burn dressing 2"x2"27031046CDM270RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
EXUDERM Satin Hydrocolloid 6.4x6.52705427CDM270RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
IN & OUT CATH TRAYCA17CDM270RCboth2816.816.80.6999999999 Percent of total billed charges20.160.72999999999 Percent of total billed charges20.50.732999999999 Percent of total billed charges23.80.85999999999 Percent of total billed charges25.20.9999999999 Percent of total billed charges19.240.687999999999 Percent of total billed charges16.825.2
IGEL Supraglottic airway2700046CDM270RCboth2917.417.40.6999999999 Percent of total billed charges20.880.72999999999 Percent of total billed charges21.230.732999999999 Percent of total billed charges24.650.85999999999 Percent of total billed charges26.10.9999999999 Percent of total billed charges19.920.687999999999 Percent of total billed charges17.426.1
LarySeal Laryngeal Airways & Mask2703894CDM270RCboth3018180.6999999999 Percent of total billed charges21.60.72999999999 Percent of total billed charges21.960.732999999999 Percent of total billed charges25.50.85999999999 Percent of total billed charges270.9999999999 Percent of total billed charges20.610.687999999999 Percent of total billed charges1827
DuoDerm Dressing 8"x8"2705445CDM270RCboth3420.420.40.6999999999 Percent of total billed charges24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges23.360.687999999999 Percent of total billed charges20.430.6
Obstetrical (OB) kits270444001CDM270RCboth3722.222.20.6999999999 Percent of total billed charges26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges25.420.687999999999 Percent of total billed charges22.233.3
TRAY FOLEY w/cathCA14CDM270RCboth3822.822.80.6999999999 Percent of total billed charges27.360.72999999999 Percent of total billed charges27.820.732999999999 Percent of total billed charges32.30.85999999999 Percent of total billed charges34.20.9999999999 Percent of total billed charges26.110.687999999999 Percent of total billed charges22.834.2
CATH FOLEY 18FRCA26CDM270RCboth3822.822.80.6999999999 Percent of total billed charges27.360.72999999999 Percent of total billed charges27.820.732999999999 Percent of total billed charges32.30.85999999999 Percent of total billed charges34.20.9999999999 Percent of total billed charges26.110.687999999999 Percent of total billed charges22.834.2
GRIPPER PORTACATH NEEDLEIV18CDM270RCboth3923.423.40.6999999999 Percent of total billed charges28.080.72999999999 Percent of total billed charges28.550.732999999999 Percent of total billed charges33.150.85999999999 Percent of total billed charges35.10.9999999999 Percent of total billed charges26.790.687999999999 Percent of total billed charges23.435.1
Compression bandage multi layerS8431CDM270RCboth4024240.6999999999 Percent of total billed charges28.80.72999999999 Percent of total billed charges29.280.732999999999 Percent of total billed charges340.85999999999 Percent of total billed charges360.9999999999 Percent of total billed charges27.480.687999999999 Percent of total billed charges2436
Pressure Infuser w/Stopcock Valve2701000CDM270RCboth4225.225.20.6999999999 Percent of total billed charges30.240.72999999999 Percent of total billed charges30.740.732999999999 Percent of total billed charges35.70.85999999999 Percent of total billed charges37.80.9999999999 Percent of total billed charges28.850.687999999999 Percent of total billed charges25.237.8
Medline catheter; closed suction2700049CDM270RCboth4225.225.20.6999999999 Percent of total billed charges30.240.72999999999 Percent of total billed charges30.740.732999999999 Percent of total billed charges35.70.85999999999 Percent of total billed charges37.80.9999999999 Percent of total billed charges28.850.687999999999 Percent of total billed charges25.237.8
CELOX (QUIK CLOT)3081212CDM270RCboth4627.627.60.6999999999 Percent of total billed charges33.120.72999999999 Percent of total billed charges33.670.732999999999 Percent of total billed charges39.10.85999999999 Percent of total billed charges41.40.9999999999 Percent of total billed charges31.60.687999999999 Percent of total billed charges27.641.4
STATLOCK PICC+ TRICOT ANCHOR3080007CDM270RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
PEDIATRIC SENSOROX27CDM270RCboth5030300.6999999999 Percent of total billed charges360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges34.350.687999999999 Percent of total billed charges3045
Hemo force seq triple bladder DVT sleeve2700027CDM270RCboth5130.630.60.6999999999 Percent of total billed charges36.720.72999999999 Percent of total billed charges37.330.732999999999 Percent of total billed charges43.350.85999999999 Percent of total billed charges45.90.9999999999 Percent of total billed charges35.040.687999999999 Percent of total billed charges30.645.9
Compression system, Fourflex 4 layer2700019CDM270RCboth5834.834.80.6999999999 Percent of total billed charges41.760.72999999999 Percent of total billed charges42.460.732999999999 Percent of total billed charges49.30.85999999999 Percent of total billed charges52.20.9999999999 Percent of total billed charges39.850.687999999999 Percent of total billed charges34.852.2
IGEL single use supraglottic airway2700047CDM270RCboth5935.435.40.6999999999 Percent of total billed charges42.480.72999999999 Percent of total billed charges43.190.732999999999 Percent of total billed charges50.150.85999999999 Percent of total billed charges53.10.9999999999 Percent of total billed charges40.530.687999999999 Percent of total billed charges35.453.1
ALGINATE Wound & Burn dressing 4"x8"27031045CDM270RCboth6036360.6999999999 Percent of total billed charges43.20.72999999999 Percent of total billed charges43.920.732999999999 Percent of total billed charges510.85999999999 Percent of total billed charges540.9999999999 Percent of total billed charges41.220.687999999999 Percent of total billed charges3654
LACERATION TRAYST5CDM270RCboth7444.444.40.6999999999 Percent of total billed charges53.280.72999999999 Percent of total billed charges54.170.732999999999 Percent of total billed charges62.90.85999999999 Percent of total billed charges66.60.9999999999 Percent of total billed charges50.840.687999999999 Percent of total billed charges44.466.6
DERMABOND AMP414575CDM270RCboth9858.858.80.6999999999 Percent of total billed charges70.560.72999999999 Percent of total billed charges71.740.732999999999 Percent of total billed charges83.30.85999999999 Percent of total billed charges88.20.9999999999 Percent of total billed charges67.330.687999999999 Percent of total billed charges58.888.2
Dressing, Aguacel surgical cover w/silveDR39CDM270RCboth10261.261.20.6999999999 Percent of total billed charges73.440.72999999999 Percent of total billed charges74.660.732999999999 Percent of total billed charges86.70.85999999999 Percent of total billed charges91.80.9999999999 Percent of total billed charges70.070.687999999999 Percent of total billed charges61.291.8
Tourniquets C A T2700048CDM270RCboth12172.672.60.6999999999 Percent of total billed charges87.120.72999999999 Percent of total billed charges88.570.732999999999 Percent of total billed charges102.850.85999999999 Percent of total billed charges108.90.9999999999 Percent of total billed charges83.130.687999999999 Percent of total billed charges72.6108.9
Oxymizer nasal cannula2700030CDM270RCboth12373.873.80.6999999999 Percent of total billed charges88.560.72999999999 Percent of total billed charges90.040.732999999999 Percent of total billed charges104.550.85999999999 Percent of total billed charges110.70.9999999999 Percent of total billed charges84.50.687999999999 Percent of total billed charges73.8110.7
HEEL OR ELBOW PROTECTOR, FOAM2700004CDM270RCboth12876.876.80.6999999999 Percent of total billed charges92.160.72999999999 Percent of total billed charges93.70.732999999999 Percent of total billed charges108.80.85999999999 Percent of total billed charges115.20.9999999999 Percent of total billed charges87.940.687999999999 Percent of total billed charges76.8115.2
Elastic net2700022CDM270RCboth15090900.6999999999 Percent of total billed charges1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges103.050.687999999999 Percent of total billed charges90135
SPLINT ARM/WRISTOR12CDM270RCboth16397.897.80.6999999999 Percent of total billed charges117.360.72999999999 Percent of total billed charges119.320.732999999999 Percent of total billed charges138.550.85999999999 Percent of total billed charges146.70.9999999999 Percent of total billed charges111.980.687999999999 Percent of total billed charges97.8146.7
Transport Mattress2700045CDM270RCboth167100.2100.20.6999999999 Percent of total billed charges120.240.72999999999 Percent of total billed charges122.240.732999999999 Percent of total billed charges141.950.85999999999 Percent of total billed charges150.30.9999999999 Percent of total billed charges114.730.687999999999 Percent of total billed charges100.2150.3
SPLINT ANKLEOR15CDM270RCboth181108.6108.60.6999999999 Percent of total billed charges130.320.72999999999 Percent of total billed charges132.490.732999999999 Percent of total billed charges153.850.85999999999 Percent of total billed charges162.90.9999999999 Percent of total billed charges124.350.687999999999 Percent of total billed charges108.6162.9
Heated breathing tube and chamber2700037CDM270RCboth203121.8121.80.6999999999 Percent of total billed charges146.160.72999999999 Percent of total billed charges148.60.732999999999 Percent of total billed charges172.550.85999999999 Percent of total billed charges182.70.9999999999 Percent of total billed charges139.460.687999999999 Percent of total billed charges121.8182.7
NASAL TAMPON308100CDM270RCboth237142.2142.20.6999999999 Percent of total billed charges170.640.72999999999 Percent of total billed charges173.480.732999999999 Percent of total billed charges201.450.85999999999 Percent of total billed charges213.30.9999999999 Percent of total billed charges162.820.687999999999 Percent of total billed charges142.2213.3
Pelvic Sling2700007CDM270RCboth252151.2151.20.6999999999 Percent of total billed charges181.440.72999999999 Percent of total billed charges184.460.732999999999 Percent of total billed charges214.20.85999999999 Percent of total billed charges226.80.9999999999 Percent of total billed charges173.120.687999999999 Percent of total billed charges151.2226.8
BIPAP SET UP3080003CDM270RCboth258154.8154.80.6999999999 Percent of total billed charges185.760.72999999999 Percent of total billed charges188.860.732999999999 Percent of total billed charges219.30.85999999999 Percent of total billed charges232.20.9999999999 Percent of total billed charges177.250.687999999999 Percent of total billed charges154.8232.2
BLOODWARMING SETUPIV41CDM270RCboth3452072070.6999999999 Percent of total billed charges248.40.72999999999 Percent of total billed charges252.540.732999999999 Percent of total billed charges293.250.85999999999 Percent of total billed charges310.50.9999999999 Percent of total billed charges237.020.687999999999 Percent of total billed charges207310.5
Thermal Angel blood warmerIV50CDM270RCboth363217.8217.80.6999999999 Percent of total billed charges261.360.72999999999 Percent of total billed charges265.720.732999999999 Percent of total billed charges308.550.85999999999 Percent of total billed charges326.70.9999999999 Percent of total billed charges249.380.687999999999 Percent of total billed charges217.8326.7
VBM Quicktrach II with cuff2700040CDM270RCboth408244.8244.80.6999999999 Percent of total billed charges293.760.72999999999 Percent of total billed charges298.660.732999999999 Percent of total billed charges346.80.85999999999 Percent of total billed charges367.20.9999999999 Percent of total billed charges280.30.687999999999 Percent of total billed charges244.8367.2
Katz Extractor Oto Rhino FB Remover2700036CDM270RCboth443265.8265.80.6999999999 Percent of total billed charges318.960.72999999999 Percent of total billed charges324.280.732999999999 Percent of total billed charges376.550.85999999999 Percent of total billed charges398.70.9999999999 Percent of total billed charges304.340.687999999999 Percent of total billed charges265.8398.7
walker boot2700051CDM270RCboth10764.264.20.6999999999 Percent of total billed charges77.040.72999999999 Percent of total billed charges78.320.732999999999 Percent of total billed charges90.950.85999999999 Percent of total billed charges96.30.9999999999 Percent of total billed charges73.510.687999999999 Percent of total billed charges64.296.3
Bubble cushion2700052CDM270RCboth3319.819.80.6999999999 Percent of total billed charges23.760.72999999999 Percent of total billed charges24.160.732999999999 Percent of total billed charges28.050.85999999999 Percent of total billed charges29.70.9999999999 Percent of total billed charges22.670.687999999999 Percent of total billed charges19.829.7
Nasal tampon, anatomical2700053CDM270RCboth3923.423.40.6999999999 Percent of total billed charges28.080.72999999999 Percent of total billed charges28.550.732999999999 Percent of total billed charges33.150.85999999999 Percent of total billed charges35.10.9999999999 Percent of total billed charges26.790.687999999999 Percent of total billed charges23.435.1
Mask w/ standard headgear2700054CDM270RCboth10563630.6999999999 Percent of total billed charges75.60.72999999999 Percent of total billed charges76.860.732999999999 Percent of total billed charges89.250.85999999999 Percent of total billed charges94.50.9999999999 Percent of total billed charges72.140.687999999999 Percent of total billed charges6394.5
Hydrofera wound dressing2700055CDM270RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
Drainable pouch2700056CDM270RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
VAGINAL SPECER31CDM270RCboth5935.435.40.6999999999 Percent of total billed charges42.480.72999999999 Percent of total billed charges43.190.732999999999 Percent of total billed charges50.150.85999999999 Percent of total billed charges53.10.9999999999 Percent of total billed charges40.530.687999999999 Percent of total billed charges35.453.1
ANKLE SPLINT1R16CDMS8451CPT271RCboth4325.825.80.6999999999 Percent of total billed charges30.960.72999999999 Percent of total billed charges31.480.732999999999 Percent of total billed charges36.550.85999999999 Percent of total billed charges38.70.9999999999 Percent of total billed charges29.540.687999999999 Percent of total billed charges25.838.7
IV PIGGYBACK SECONDARYIV5CDM271RCboth0.01
ELASTIKON ELASTIC TAPE 3X5MI11CDM271RCboth0.01
ARM BOARD IVOR24CDM271RCboth0.01
O2 HUMIDIFEROX3CDM271RCboth0.01
ACE BANDAGE ANY SIZE1R8CDM271RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
BETADINEMI2CDM271RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
KLING BANDAGE 4X75DR13CDM271RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
PEDI NASA CANULAOX15CDM271RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
XEROFORM308001CDM271RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
AEROSOL MASKOX6CDM271RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
ADULT OXYGEN MASKOX5CDM271RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
MASK NON REBREATHER ADULTOX13CDM271RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
FEMALE CATHCA10CDM271RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
ENEMA KITPR9CDM271RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
ZZMASK O2 DISP EAR500624CDM271RCboth63.63.60.6999999999 Percent of total billed charges4.320.72999999999 Percent of total billed charges4.390.732999999999 Percent of total billed charges5.10.85999999999 Percent of total billed charges5.40.9999999999 Percent of total billed charges4.120.687999999999 Percent of total billed charges3.65.4
NASAL CANNULA O2 DISPOX16CDM271RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
ZZCANNULA O2 DISP EAR500625CDM271RCboth74.24.20.6999999999 Percent of total billed charges5.040.72999999999 Percent of total billed charges5.120.732999999999 Percent of total billed charges5.950.85999999999 Percent of total billed charges6.30.9999999999 Percent of total billed charges4.810.687999999999 Percent of total billed charges4.26.3
FINGER SPLINT1R12CDM271RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
IV START KITCT2CDM271RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
OZZ2 HUMIDIFIERR500303CDM271RCboth10660.6999999999 Percent of total billed charges7.20.72999999999 Percent of total billed charges7.320.732999999999 Percent of total billed charges8.50.85999999999 Percent of total billed charges90.9999999999 Percent of total billed charges6.870.687999999999 Percent of total billed charges69
SPLINT FINGEROR11CDM271RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
Dressing, tegaderm, transfilmOR21CDM271RCboth137.87.80.6999999999 Percent of total billed charges9.360.72999999999 Percent of total billed charges9.520.732999999999 Percent of total billed charges11.050.85999999999 Percent of total billed charges11.70.9999999999 Percent of total billed charges8.930.687999999999 Percent of total billed charges7.811.7
TEGADERM HYDROCOLLOID308104CDM271RCboth1911.411.40.6999999999 Percent of total billed charges13.680.72999999999 Percent of total billed charges13.910.732999999999 Percent of total billed charges16.150.85999999999 Percent of total billed charges17.10.9999999999 Percent of total billed charges13.050.687999999999 Percent of total billed charges11.417.1
CATH DRAIN BAGCA8CDM271RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
COLLES SPLINTOR25CDM271RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
SPLINT WRIST1R19CDM271RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
ARM SPLINT1R13CDM271RCboth3219.219.20.6999999999 Percent of total billed charges23.040.72999999999 Percent of total billed charges23.420.732999999999 Percent of total billed charges27.20.85999999999 Percent of total billed charges28.80.9999999999 Percent of total billed charges21.980.687999999999 Percent of total billed charges19.228.8
DVT CALF GARMENT3080002CDM271RCboth3521210.6999999999 Percent of total billed charges25.20.72999999999 Percent of total billed charges25.620.732999999999 Percent of total billed charges29.750.85999999999 Percent of total billed charges31.50.9999999999 Percent of total billed charges24.050.687999999999 Percent of total billed charges2131.5
SP02 Sensor Neo-Adult, disp.ER13CDM271RCboth4225.225.20.6999999999 Percent of total billed charges30.240.72999999999 Percent of total billed charges30.740.732999999999 Percent of total billed charges35.70.85999999999 Percent of total billed charges37.80.9999999999 Percent of total billed charges28.850.687999999999 Percent of total billed charges25.237.8
SET CONTINUE FLO 60MLIV25CDM271RCboth4527270.6999999999 Percent of total billed charges32.40.72999999999 Percent of total billed charges32.940.732999999999 Percent of total billed charges38.250.85999999999 Percent of total billed charges40.50.9999999999 Percent of total billed charges30.920.687999999999 Percent of total billed charges2740.5
AMBU BAGER36CDM271RCboth10864.864.80.6999999999 Percent of total billed charges77.760.72999999999 Percent of total billed charges79.060.732999999999 Percent of total billed charges91.80.85999999999 Percent of total billed charges97.20.9999999999 Percent of total billed charges74.20.687999999999 Percent of total billed charges64.897.2
VAR--RESUSCITATORER41CDM271RCboth2301381380.6999999999 Percent of total billed charges165.60.72999999999 Percent of total billed charges168.360.732999999999 Percent of total billed charges195.50.85999999999 Percent of total billed charges2070.9999999999 Percent of total billed charges158.010.687999999999 Percent of total billed charges138207
IMMOBILIZER MULTIGRIP ADULTTR3CDM271RCboth4024240.6999999999 Percent of total billed charges28.80.72999999999 Percent of total billed charges29.280.732999999999 Percent of total billed charges340.85999999999 Percent of total billed charges360.9999999999 Percent of total billed charges27.480.687999999999 Percent of total billed charges2436
IMMOBILIZER MULTI GRIP INFANTTR5CDM271RCboth3722.222.20.6999999999 Percent of total billed charges26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges25.420.687999999999 Percent of total billed charges22.233.3
PARACENTESIS TRAYER7CDMA4550CPT272RCboth278166.8166.80.6999999999 Percent of total billed charges200.160.72999999999 Percent of total billed charges203.50.732999999999 Percent of total billed charges236.30.85999999999 Percent of total billed charges250.20.9999999999 Percent of total billed charges190.990.687999999999 Percent of total billed charges166.8250.2
ABD 8X7DR27CDMA6253CPT272RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
EYE PADSMI18CDMA6410CPT272RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
INTRAOSSEOUS NEEDLEIV35CDM272RCboth0.01
TELFA PADDR23CDM272RCboth0.01
DRESSING KERLIX 4X41R3CDM272RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
SYRINGE 60 ML DISPIV34CDM272RCboth10.60.60.6999999999 Percent of total billed charges0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges0.690.687999999999 Percent of total billed charges0.60.9
TEGADERMDR18CDM272RCboth21.21.20.6999999999 Percent of total billed charges1.440.72999999999 Percent of total billed charges1.460.732999999999 Percent of total billed charges1.70.85999999999 Percent of total billed charges1.80.9999999999 Percent of total billed charges1.370.687999999999 Percent of total billed charges1.21.8
HYDROGEN PEROXIDEMI1CDM272RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
NASAL CANNULA ADULT W/ EARPCS308102CDM272RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
TRACHEOSTOMY CARE TRAYER30CDM272RCboth31.81.80.6999999999 Percent of total billed charges2.160.72999999999 Percent of total billed charges2.20.732999999999 Percent of total billed charges2.550.85999999999 Percent of total billed charges2.70.9999999999 Percent of total billed charges2.060.687999999999 Percent of total billed charges1.82.7
NORMAL SALINE 500ML IRRIGATIONA540785CDM272RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
DRESSING bulkee 4x4DR14CDM272RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
TUBE GAUZEDR24CDM272RCboth42.42.40.6999999999 Percent of total billed charges2.880.72999999999 Percent of total billed charges2.930.732999999999 Percent of total billed charges3.40.85999999999 Percent of total billed charges3.60.9999999999 Percent of total billed charges2.750.687999999999 Percent of total billed charges2.43.6
TEGADERM 8X12DR21CDM272RCboth5330.6999999999 Percent of total billed charges3.60.72999999999 Percent of total billed charges3.660.732999999999 Percent of total billed charges4.250.85999999999 Percent of total billed charges4.50.9999999999 Percent of total billed charges3.440.687999999999 Percent of total billed charges34.5
VASELINE GAUZEDR25CDM272RCboth84.84.80.6999999999 Percent of total billed charges5.760.72999999999 Percent of total billed charges5.860.732999999999 Percent of total billed charges6.80.85999999999 Percent of total billed charges7.20.9999999999 Percent of total billed charges5.50.687999999999 Percent of total billed charges4.87.2
NUGAUZE PACKING STRIPSDR11ACDM272RCboth116.66.60.6999999999 Percent of total billed charges7.920.72999999999 Percent of total billed charges8.050.732999999999 Percent of total billed charges9.350.85999999999 Percent of total billed charges9.90.9999999999 Percent of total billed charges7.560.687999999999 Percent of total billed charges6.69.9
IODOFORM 1/4DR33ACDM272RCboth148.48.40.6999999999 Percent of total billed charges10.080.72999999999 Percent of total billed charges10.250.732999999999 Percent of total billed charges11.90.85999999999 Percent of total billed charges12.60.9999999999 Percent of total billed charges9.620.687999999999 Percent of total billed charges8.412.6
CATH in out trayCA7CDM272RCboth2112.612.60.6999999999 Percent of total billed charges15.120.72999999999 Percent of total billed charges15.370.732999999999 Percent of total billed charges17.850.85999999999 Percent of total billed charges18.90.9999999999 Percent of total billed charges14.430.687999999999 Percent of total billed charges12.618.9
NASO PARYNGEAL AIRWAYER17CDM272RCboth2615.615.60.6999999999 Percent of total billed charges18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges17.860.687999999999 Percent of total billed charges15.623.4
VENTED INITRO SETIV33CDM272RCboth2716.216.20.6999999999 Percent of total billed charges19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges18.550.687999999999 Percent of total billed charges16.224.3
Insertion In/Out TrayCA27CDM272RCboth2816.816.80.6999999999 Percent of total billed charges20.160.72999999999 Percent of total billed charges20.50.732999999999 Percent of total billed charges23.80.85999999999 Percent of total billed charges25.20.9999999999 Percent of total billed charges19.240.687999999999 Percent of total billed charges16.825.2
NG SET UPER35CDM272RCboth4929.429.40.6999999999 Percent of total billed charges35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges33.660.687999999999 Percent of total billed charges29.444.1
IV BLOOD Y SETIV42CDM272RCboth7042420.6999999999 Percent of total billed charges50.40.72999999999 Percent of total billed charges51.240.732999999999 Percent of total billed charges59.50.85999999999 Percent of total billed charges630.9999999999 Percent of total billed charges48.090.687999999999 Percent of total billed charges4263
CENTRAL LINE DRESSING TRAYDR35CDM272RCboth10462.462.40.6999999999 Percent of total billed charges74.880.72999999999 Percent of total billed charges76.130.732999999999 Percent of total billed charges88.40.85999999999 Percent of total billed charges93.60.9999999999 Percent of total billed charges71.450.687999999999 Percent of total billed charges62.493.6
CATH TROCAR ANY SIZECA5CDM272RCboth12072720.6999999999 Percent of total billed charges86.40.72999999999 Percent of total billed charges87.840.732999999999 Percent of total billed charges1020.85999999999 Percent of total billed charges1080.9999999999 Percent of total billed charges82.440.687999999999 Percent of total billed charges72108
PNEUMOTHORAX SET 8.5 FRTR6CDM272RCboth398238.8238.80.6999999999 Percent of total billed charges286.560.72999999999 Percent of total billed charges291.340.732999999999 Percent of total billed charges338.30.85999999999 Percent of total billed charges358.20.9999999999 Percent of total billed charges273.430.687999999999 Percent of total billed charges238.8358.2
DRESSING DUODERM 4X4 CGFDR8CDM272RCboth169.69.60.6999999999 Percent of total billed charges11.520.72999999999 Percent of total billed charges11.710.732999999999 Percent of total billed charges13.60.85999999999 Percent of total billed charges14.40.9999999999 Percent of total billed charges10.990.687999999999 Percent of total billed charges9.614.4
COLLECTION OF VENOUS BLOOD36415CDM36415CPT300RCboth148.4999999999 Percent of total billed charges
Acces implanted venous device36591CDM36591CPT300RCboth4002402400.6999999999 Percent of total billed charges334.63999999999Fee schedule372.01999999999Fee schedule372.01999999999Fee schedule2880.72999999999 Percent of total billed charges292.80.732999999999 Percent of total billed charges3400.85999999999 Percent of total billed charges3600.9999999999 Percent of total billed charges70999999999 Fee schedule70372.01
Chem 630080047CDM80047CPT300RCboth324194.4194.40.6999999999 Percent of total billed charges42.28999999999Fee schedule47999999999Fee schedule47999999999Fee schedule233.280.72999999999 Percent of total billed charges237.170.732999999999 Percent of total billed charges275.40.85999999999 Percent of total billed charges291.60.9999999999 Percent of total billed charges70999999999 Fee schedule42.28291.6
ISTAT BMP30080048CDM80048CPT300RCboth7746.246.20.6999999999 Percent of total billed charges42.28999999999Fee schedule47999999999Fee schedule47999999999Fee schedule55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges70999999999 Fee schedule42.2870
General Health Panel (CBC,TSH,CMP)30080050CDM80050CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges128.78999999999Fee schedule143.17999999999Fee schedule143.17999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70275.4
Amiodarone drug assay30080151CDM80151CPT300RCboth5935.435.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule42.480.72999999999 Percent of total billed charges43.190.732999999999 Percent of total billed charges50.150.85999999999 Percent of total billed charges53.10.9999999999 Percent of total billed charges59999999999 Fee schedule35.459
Lamotrigine30080175CDM80175CPT300RCboth7545450.6999999999 Percent of total billed charges66.28999999999Fee schedule73.68999999999Fee schedule73.68999999999Fee schedule540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges70999999999 Fee schedule4573.68
PHENOBARBITAL335708CDM80184CPT300RCboth7343.843.80.6999999999 Percent of total billed charges57.25999999999Fee schedule63.65999999999Fee schedule63.65999999999Fee schedule52.560.72999999999 Percent of total billed charges53.440.732999999999 Percent of total billed charges62.050.85999999999 Percent of total billed charges65.70.9999999999 Percent of total billed charges70999999999 Fee schedule43.870
Tacrolimus, highly sensitive30080197CDM80197CPT300RCboth12977.477.40.6999999999 Percent of total billed charges68.67999999999Fee schedule76.34999999999Fee schedule76.34999999999Fee schedule92.880.72999999999 Percent of total billed charges94.430.732999999999 Percent of total billed charges109.650.85999999999 Percent of total billed charges116.10.9999999999 Percent of total billed charges70999999999 Fee schedule68.67116.1
Clobazam Metabolite Serum/plasma30080299CDM80299CPT300RCboth578346.8346.80.6999999999 Percent of total billed charges68.48999999999Fee schedule76.13999999999Fee schedule76.13999999999Fee schedule416.160.72999999999 Percent of total billed charges423.10.732999999999 Percent of total billed charges491.30.85999999999 Percent of total billed charges520.20.9999999999 Percent of total billed charges70999999999 Fee schedule68.48520.2
DRUG SCREEN Employee801001CDM80305CPT300RCboth7746.246.20.6999999999 Percent of total billed charges41.98999999999Fee schedule46.68999999999Fee schedule46.68999999999Fee schedule55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges70999999999 Fee schedule41.9870
DRUG SCREEN presumptive30080300CDM80305CPT300RCboth15090900.6999999999 Percent of total billed charges41.98999999999Fee schedule46.68999999999Fee schedule46.68999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule41.98135
Phosphatidylethanol33537850CDM80321CPT300RCboth349209.4209.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule251.280.72999999999 Percent of total billed charges255.470.732999999999 Percent of total billed charges296.650.85999999999 Percent of total billed charges314.10.9999999999 Percent of total billed charges70999999999 Fee schedule70314.1
SALICYLATE LEVEL, PLASMA80196CDM80329CPT300RCboth188112.8112.80.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule135.360.72999999999 Percent of total billed charges137.620.732999999999 Percent of total billed charges159.80.85999999999 Percent of total billed charges169.20.9999999999 Percent of total billed charges70999999999 Fee schedule70169.2
Drug screen barbituates30080345CDM80345CPT300RCboth6136.636.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule36.661
Skeletal muschle relaxant30080369CDM80369CPT300RCboth6136.636.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule36.661
Drug screen nos 1-330080375CDM80375CPT300RCboth6136.636.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule36.661
BRCA Panel30081162CDM81162CPT300RCboth10500630063000.6999999999 Percent of total billed charges9123.11999999999Fee schedule10142.31999999999Fee schedule10142.31999999999Fee schedule75600.72999999999 Percent of total billed charges76860.732999999999 Percent of total billed charges89250.85999999999 Percent of total billed charges94500.9999999999 Percent of total billed charges70999999999 Fee schedule7010142.31
Prothrombin Factor II30081240CDM81240CPT300RCboth2751651650.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule1980.72999999999 Percent of total billed charges201.30.732999999999 Percent of total billed charges233.750.85999999999 Percent of total billed charges247.50.9999999999 Percent of total billed charges70999999999 Fee schedule70247.5
Hereditary Hemo81256CDM81256CPT300RCboth377226.2226.20.6999999999 Percent of total billed charges326.78999999999Fee schedule363.28999999999Fee schedule363.28999999999Fee schedule271.440.72999999999 Percent of total billed charges275.960.732999999999 Percent of total billed charges320.450.85999999999 Percent of total billed charges339.30.9999999999 Percent of total billed charges70999999999 Fee schedule70363.28
JAK2 Gene Analysis33581270CDM81270CPT300RCboth15009009000.6999999999 Percent of total billed charges458.27999999999Fee schedule509.47999999999Fee schedule509.47999999999Fee schedule10800.72999999999 Percent of total billed charges10980.732999999999 Percent of total billed charges12750.85999999999 Percent of total billed charges13500.9999999999 Percent of total billed charges70999999999 Fee schedule701350
Liver Fibrosis, FebroTest-Acti Test Pane30081596CDM81596CPT300RCboth866519.6519.60.6999999999 Percent of total billed charges264.94999999999Fee schedule294.54999999999Fee schedule294.54999999999Fee schedule623.520.72999999999 Percent of total billed charges633.910.732999999999 Percent of total billed charges736.10.85999999999 Percent of total billed charges779.40.9999999999 Percent of total billed charges70999999999 Fee schedule70779.4
ACTH33582024CDM82024CPT300RCboth224134.4134.40.6999999999 Percent of total billed charges193.08999999999Fee schedule214.65999999999Fee schedule214.65999999999Fee schedule161.280.72999999999 Percent of total billed charges163.970.732999999999 Percent of total billed charges190.40.85999999999 Percent of total billed charges201.60.9999999999 Percent of total billed charges70999999999 Fee schedule70214.65
MICRO ALBUMIN84822ACDM82043CPT300RCboth184110.4110.40.6999999999 Percent of total billed charges27.86999999999Fee schedule30.97999999999Fee schedule30.97999999999Fee schedule132.480.72999999999 Percent of total billed charges134.690.732999999999 Percent of total billed charges156.40.85999999999 Percent of total billed charges165.60.9999999999 Percent of total billed charges70999999999 Fee schedule27.86165.6
Alpha 1 Antitrypsin Phenotype30082104CDM82104CPT300RCboth9054540.6999999999 Percent of total billed charges72.3999999999Fee schedule80.38999999999Fee schedule80.38999999999Fee schedule64.80.72999999999 Percent of total billed charges65.880.732999999999 Percent of total billed charges76.50.85999999999 Percent of total billed charges810.9999999999 Percent of total billed charges70999999999 Fee schedule5481
Androstenedione82157CDM82157CPT300RCboth173103.8103.80.6999999999 Percent of total billed charges146.36999999999Fee schedule162.71999999999Fee schedule162.71999999999Fee schedule124.560.72999999999 Percent of total billed charges126.640.732999999999 Percent of total billed charges147.050.85999999999 Percent of total billed charges155.70.9999999999 Percent of total billed charges70999999999 Fee schedule70162.71
Lipoprotein30082172CDM82172CPT300RCboth10060600.6999999999 Percent of total billed charges77.47999999999Fee schedule86.13999999999Fee schedule86.13999999999Fee schedule720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges70999999999 Fee schedule6090
Apolipoprotein B3000051CDM82172CPT300RCboth10060600.6999999999 Percent of total billed charges77.47999999999Fee schedule86.13999999999Fee schedule86.13999999999Fee schedule720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges70999999999 Fee schedule6090
VITAMIN D 25 HYDROXY33517306CDM82306CPT300RCboth15894.894.80.6999999999 Percent of total billed charges135.86999999999Fee schedule151.04999999999Fee schedule151.04999999999Fee schedule113.760.72999999999 Percent of total billed charges115.660.732999999999 Percent of total billed charges134.30.85999999999 Percent of total billed charges142.20.9999999999 Percent of total billed charges70999999999 Fee schedule70151.04
Anti mullerian hormone82397CDM82397CPT300RCboth312187.2187.20.6999999999 Percent of total billed charges70.61999999999Fee schedule78.5999999999Fee schedule78.5999999999Fee schedule224.640.72999999999 Percent of total billed charges228.380.732999999999 Percent of total billed charges265.20.85999999999 Percent of total billed charges280.80.9999999999 Percent of total billed charges70999999999 Fee schedule70280.8
CHROMIUM, BLOOD3355248CDM82495CPT300RCboth13480.480.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule96.480.72999999999 Percent of total billed charges98.090.732999999999 Percent of total billed charges113.90.85999999999 Percent of total billed charges120.60.9999999999 Percent of total billed charges70999999999 Fee schedule70120.6
Collagen Type 1 C-Telopeptide CTx30082523CDM82523CPT300RCboth186111.6111.60.6999999999 Percent of total billed charges93.44999999999Fee schedule103.88999999999Fee schedule103.88999999999Fee schedule133.920.72999999999 Percent of total billed charges136.150.732999999999 Percent of total billed charges158.10.85999999999 Percent of total billed charges167.40.9999999999 Percent of total billed charges70999999999 Fee schedule70167.4
OmegaCheck30082542CDM82542CPT300RCboth15090900.6999999999 Percent of total billed charges90.28999999999Fee schedule100.37999999999Fee schedule100.37999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule70135
Cystatin c; Estimated eGFR30082610CDM82610CPT300RCboth188112.8112.80.6999999999 Percent of total billed charges67.97999999999Fee schedule75.56999999999Fee schedule75.56999999999Fee schedule135.360.72999999999 Percent of total billed charges137.620.732999999999 Percent of total billed charges159.80.85999999999 Percent of total billed charges169.20.9999999999 Percent of total billed charges70999999999 Fee schedule67.97169.2
DI Testeosterone30082642CDM82642CPT300RCboth15090900.6999999999 Percent of total billed charges119.39999999999Fee schedule132.72999999999Fee schedule132.72999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule70135
Pancreatic Elastace 130082653CDM82653CPT300RCboth4502702700.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule3240.72999999999 Percent of total billed charges329.40.732999999999 Percent of total billed charges382.50.85999999999 Percent of total billed charges4050.9999999999 Percent of total billed charges70999999999 Fee schedule70405
Estrone30082679CDM82679CPT300RCboth15090900.6999999999 Percent of total billed charges124.78999999999Fee schedule138.72999999999Fee schedule138.72999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule70138.72
GAMMAGLOBULIN IGA IGD IGM EAA33515980CDM82784CPT300RCboth14184.684.60.6999999999 Percent of total billed charges46.5999999999Fee schedule51.69999999999Fee schedule51.69999999999Fee schedule101.520.72999999999 Percent of total billed charges103.210.732999999999 Percent of total billed charges119.850.85999999999 Percent of total billed charges126.90.9999999999 Percent of total billed charges70999999999 Fee schedule46.5126.9
IGE, SERUM335542CDM82784CPT300RCboth14184.684.60.6999999999 Percent of total billed charges46.5999999999Fee schedule51.69999999999Fee schedule51.69999999999Fee schedule101.520.72999999999 Percent of total billed charges103.210.732999999999 Percent of total billed charges119.850.85999999999 Percent of total billed charges126.90.9999999999 Percent of total billed charges70999999999 Fee schedule46.5126.9
IgA total30082784CDM82784CPT300RCboth14184.684.60.6999999999 Percent of total billed charges46.5999999999Fee schedule51.69999999999Fee schedule51.69999999999Fee schedule101.520.72999999999 Percent of total billed charges103.210.732999999999 Percent of total billed charges119.850.85999999999 Percent of total billed charges126.90.9999999999 Percent of total billed charges70999999999 Fee schedule46.5126.9
Immunoglobulin E30082785CDM82785CPT300RCboth10060600.6999999999 Percent of total billed charges82.32999999999Fee schedule91.51999999999Fee schedule91.51999999999Fee schedule720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges70999999999 Fee schedule6091.51
BLOOD REAGENT STRIPGLM200CDM82948CPT300RCboth2012120.6999999999 Percent of total billed charges15.85999999999Fee schedule17.63999999999Fee schedule17.63999999999Fee schedule14.40.72999999999 Percent of total billed charges14.640.732999999999 Percent of total billed charges170.85999999999 Percent of total billed charges180.9999999999 Percent of total billed charges20999999999 Fee schedule1220
Oral glucose tolerance test30082950CDM82950CPT300RCboth6136.636.60.6999999999 Percent of total billed charges23.74999999999Fee schedule26.4999999999Fee schedule26.4999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule23.7461
GLUCOSE TOLERANCE 3 SPECIMENSG82951CDM82951CPT300RCboth10864.864.80.6999999999 Percent of total billed charges64.34999999999Fee schedule71.52999999999Fee schedule71.52999999999Fee schedule77.760.72999999999 Percent of total billed charges79.060.732999999999 Percent of total billed charges91.80.85999999999 Percent of total billed charges97.20.9999999999 Percent of total billed charges70999999999 Fee schedule64.3497.2
GLUCOSE EACH ADDITIONAL SPECG82952CDM82952CPT300RCboth10864.864.80.6999999999 Percent of total billed charges19.6999999999Fee schedule21.79999999999Fee schedule21.79999999999Fee schedule77.760.72999999999 Percent of total billed charges79.060.732999999999 Percent of total billed charges91.80.85999999999 Percent of total billed charges97.20.9999999999 Percent of total billed charges70999999999 Fee schedule19.697.2
Glucose 6 phosphate dehydrogenase, Quant30082955CDM82955CPT300RCboth5030300.6999999999 Percent of total billed charges43.71999999999Fee schedule48.59999999999Fee schedule48.59999999999Fee schedule360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges50999999999 Fee schedule3050
Growth hormone30083003CDM83003CPT300RCboth4929.429.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges49999999999 Fee schedule29.449
HAPTOGLOBIN, SERUM335502CDM83010CPT300RCboth8551510.6999999999 Percent of total billed charges62.87999999999Fee schedule69.89999999999Fee schedule69.89999999999Fee schedule61.20.72999999999 Percent of total billed charges62.220.732999999999 Percent of total billed charges72.250.85999999999 Percent of total billed charges76.50.9999999999 Percent of total billed charges70999999999 Fee schedule5176.5
Titanium, serum/plasma3000053CDM83018CPT300RCboth2251351350.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule1620.72999999999 Percent of total billed charges164.70.732999999999 Percent of total billed charges191.250.85999999999 Percent of total billed charges202.50.9999999999 Percent of total billed charges70999999999 Fee schedule70202.5
Cobalf30083018CDM83018CPT300RCboth2251351350.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule1620.72999999999 Percent of total billed charges164.70.732999999999 Percent of total billed charges191.250.85999999999 Percent of total billed charges202.50.9999999999 Percent of total billed charges70999999999 Fee schedule70202.5
INFECT AGENT ANTIGENB33515980CDM83516CPT300RCboth7042420.6999999999 Percent of total billed charges57.66999999999Fee schedule64.1999999999Fee schedule64.1999999999Fee schedule50.40.72999999999 Percent of total billed charges51.240.732999999999 Percent of total billed charges59.50.85999999999 Percent of total billed charges630.9999999999 Percent of total billed charges70999999999 Fee schedule4270
Celiac Disease Panel33583516CDM83516CPT300RCboth7042420.6999999999 Percent of total billed charges57.66999999999Fee schedule64.1999999999Fee schedule64.1999999999Fee schedule50.40.72999999999 Percent of total billed charges51.240.732999999999 Percent of total billed charges59.50.85999999999 Percent of total billed charges630.9999999999 Percent of total billed charges70999999999 Fee schedule4270
Tissue transglutaminase IgG antibody30083516CDM83516CPT300RCboth689413.4413.40.6999999999 Percent of total billed charges57.66999999999Fee schedule64.1999999999Fee schedule64.1999999999Fee schedule496.080.72999999999 Percent of total billed charges504.350.732999999999 Percent of total billed charges585.650.85999999999 Percent of total billed charges620.10.9999999999 Percent of total billed charges70999999999 Fee schedule57.66620.1
Gliadin IgA antibody assay83516CDM83516CPT300RCboth689413.4413.40.6999999999 Percent of total billed charges57.66999999999Fee schedule64.1999999999Fee schedule64.1999999999Fee schedule496.080.72999999999 Percent of total billed charges504.350.732999999999 Percent of total billed charges585.650.85999999999 Percent of total billed charges620.10.9999999999 Percent of total billed charges70999999999 Fee schedule57.66620.1
Glutamic Acid Decarbox Autoaby33583519CDM83519CPT300RCboth263157.8157.80.6999999999 Percent of total billed charges67.53999999999Fee schedule75.07999999999Fee schedule75.07999999999Fee schedule189.360.72999999999 Percent of total billed charges192.520.732999999999 Percent of total billed charges223.550.85999999999 Percent of total billed charges236.70.9999999999 Percent of total billed charges70999999999 Fee schedule67.53236.7
Procollagen Type 1 Intact N Term Prop3000007CDM83519CPT300RCboth5003003000.6999999999 Percent of total billed charges67.53999999999Fee schedule75.07999999999Fee schedule75.07999999999Fee schedule3600.72999999999 Percent of total billed charges3660.732999999999 Percent of total billed charges4250.85999999999 Percent of total billed charges4500.9999999999 Percent of total billed charges70999999999 Fee schedule67.53450
Musk AB Serum30083519CDM83519CPT300RCboth2040122412240.6999999999 Percent of total billed charges67.53999999999Fee schedule75.07999999999Fee schedule75.07999999999Fee schedule1468.80.72999999999 Percent of total billed charges1493.280.732999999999 Percent of total billed charges17340.85999999999 Percent of total billed charges18360.9999999999 Percent of total billed charges70999999999 Fee schedule67.531836
Co GM1 Triad3000004CDM83520CPT300RCboth7545450.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges70999999999 Fee schedule4571.93
Leptin30083520CDM83520CPT300RCboth9255.255.20.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule66.240.72999999999 Percent of total billed charges67.340.732999999999 Percent of total billed charges78.20.85999999999 Percent of total billed charges82.80.9999999999 Percent of total billed charges70999999999 Fee schedule55.282.8
TSH receptor anitbody TRAB3000006CDM83520CPT300RCboth10160.660.60.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule72.720.72999999999 Percent of total billed charges73.930.732999999999 Percent of total billed charges85.850.85999999999 Percent of total billed charges90.90.9999999999 Percent of total billed charges70999999999 Fee schedule60.690.9
Ganglioside GM1 AB3000022CDM83520CPT300RCboth232139.2139.20.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule167.040.72999999999 Percent of total billed charges169.820.732999999999 Percent of total billed charges197.20.85999999999 Percent of total billed charges208.80.9999999999 Percent of total billed charges70999999999 Fee schedule64.7208.8
Gonadotropin83520CDM83520CPT300RCboth627376.2376.20.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule451.440.72999999999 Percent of total billed charges458.960.732999999999 Percent of total billed charges532.950.85999999999 Percent of total billed charges564.30.9999999999 Percent of total billed charges70999999999 Fee schedule64.7564.3
Light chains free; each30083521CDM83521CPT300RCboth332199.2199.20.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule239.040.72999999999 Percent of total billed charges243.020.732999999999 Percent of total billed charges282.20.85999999999 Percent of total billed charges298.80.9999999999 Percent of total billed charges70999999999 Fee schedule70298.8
IRON AND TIBC3357573CDM83540CPT300RCboth13379.879.80.6999999999 Percent of total billed charges32.37999999999Fee schedule35.99999999999Fee schedule35.99999999999Fee schedule95.760.72999999999 Percent of total billed charges97.360.732999999999 Percent of total billed charges113.050.85999999999 Percent of total billed charges119.70.9999999999 Percent of total billed charges70999999999 Fee schedule32.37119.7
IRON AND TIBC 2ND COMPG83550CDM83550CPT300RCboth7343.843.80.6999999999 Percent of total billed charges43.71999999999Fee schedule48.59999999999Fee schedule48.59999999999Fee schedule52.560.72999999999 Percent of total billed charges53.440.732999999999 Percent of total billed charges62.050.85999999999 Percent of total billed charges65.70.9999999999 Percent of total billed charges70999999999 Fee schedule43.7170
LACTIC ACID83605CDM83605CPT300RCboth15090900.6999999999 Percent of total billed charges53.4999999999Fee schedule59.36999999999Fee schedule59.36999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule53.4135
ISTAT Lactic Acid30083605CDM83605CPT300RCboth204122.4122.40.6999999999 Percent of total billed charges53.4999999999Fee schedule59.36999999999Fee schedule59.36999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule53.4183.6
LDH335593CDM83615CPT300RCboth3621.621.60.6999999999 Percent of total billed charges30.17999999999Fee schedule33.54999999999Fee schedule33.54999999999Fee schedule25.920.72999999999 Percent of total billed charges26.350.732999999999 Percent of total billed charges30.60.85999999999 Percent of total billed charges32.40.9999999999 Percent of total billed charges36999999999 Fee schedule21.636
Lactoferrin fecal qualitative30083630CDM83630CPT300RCboth2151291290.6999999999 Percent of total billed charges98.14999999999Fee schedule109.1999999999Fee schedule109.1999999999Fee schedule154.80.72999999999 Percent of total billed charges157.380.732999999999 Percent of total billed charges182.750.85999999999 Percent of total billed charges193.50.9999999999 Percent of total billed charges70999999999 Fee schedule70193.5
LIPASE, SERUM83690CDM83690CPT300RCboth4728.228.20.6999999999 Percent of total billed charges34.42999999999Fee schedule38.27999999999Fee schedule38.27999999999Fee schedule33.840.72999999999 Percent of total billed charges34.40.732999999999 Percent of total billed charges39.950.85999999999 Percent of total billed charges42.30.9999999999 Percent of total billed charges47999999999 Fee schedule28.247
Lipoprotein(a)30083695CDM83695CPT300RCboth12977.477.40.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule92.880.72999999999 Percent of total billed charges94.430.732999999999 Percent of total billed charges109.650.85999999999 Percent of total billed charges116.10.9999999999 Percent of total billed charges70999999999 Fee schedule64.7116.1
Lp-PLA2 Activity30083698CDM83698CPT300RCboth2001201200.6999999999 Percent of total billed charges169.7999999999Fee schedule188.66999999999Fee schedule188.66999999999Fee schedule1440.72999999999 Percent of total billed charges146.40.732999999999 Percent of total billed charges1700.85999999999 Percent of total billed charges1800.9999999999 Percent of total billed charges70999999999 Fee schedule70188.66
MYOGLOBIN83874CDM83874CPT300RCboth8048480.6999999999 Percent of total billed charges64.56999999999Fee schedule71.77999999999Fee schedule71.77999999999Fee schedule57.60.72999999999 Percent of total billed charges58.560.732999999999 Percent of total billed charges680.85999999999 Percent of total billed charges720.9999999999 Percent of total billed charges70999999999 Fee schedule4872
Myeloperoxidase30083876CDM83876CPT300RCboth2001201200.6999999999 Percent of total billed charges169.7999999999Fee schedule188.66999999999Fee schedule188.66999999999Fee schedule1440.72999999999 Percent of total billed charges146.40.732999999999 Percent of total billed charges1700.85999999999 Percent of total billed charges1800.9999999999 Percent of total billed charges70999999999 Fee schedule70188.66
NT Pro BNP30083880CDM83880CPT300RCboth387232.2232.20.6999999999 Percent of total billed charges169.7999999999Fee schedule188.66999999999Fee schedule188.66999999999Fee schedule278.640.72999999999 Percent of total billed charges283.280.732999999999 Percent of total billed charges328.950.85999999999 Percent of total billed charges348.30.9999999999 Percent of total billed charges70999999999 Fee schedule70348.3
Methylmalonic Acid30083921CDM83921CPT300RCboth13882.882.80.6999999999 Percent of total billed charges82.24999999999Fee schedule91.43999999999Fee schedule91.43999999999Fee schedule99.360.72999999999 Percent of total billed charges101.020.732999999999 Percent of total billed charges117.30.85999999999 Percent of total billed charges124.20.9999999999 Percent of total billed charges70999999999 Fee schedule70124.2
Osteocalcin30083937CDM83937CPT300RCboth1751051050.6999999999 Percent of total billed charges142.36999999999Fee schedule158.26999999999Fee schedule158.26999999999Fee schedule1260.72999999999 Percent of total billed charges128.10.732999999999 Percent of total billed charges148.750.85999999999 Percent of total billed charges157.50.9999999999 Percent of total billed charges70999999999 Fee schedule70158.26
Calprotectin30083993CDM83993CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges98.14999999999Fee schedule109.1999999999Fee schedule109.1999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70275.4
Phosphate 24 hr urine33511319CDM84105CPT300RCboth13178.678.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule94.320.72999999999 Percent of total billed charges95.890.732999999999 Percent of total billed charges111.350.85999999999 Percent of total billed charges117.90.9999999999 Percent of total billed charges70999999999 Fee schedule70117.9
Urine potassium30084133CDM84133CPT300RCboth12172.672.60.6999999999 Percent of total billed charges21.51999999999Fee schedule23.91999999999Fee schedule23.91999999999Fee schedule87.120.72999999999 Percent of total billed charges88.570.732999999999 Percent of total billed charges102.850.85999999999 Percent of total billed charges108.90.9999999999 Percent of total billed charges70999999999 Fee schedule21.51108.9
Pregnenolone serum30084140CDM84140CPT300RCboth199119.4119.40.6999999999 Percent of total billed charges103.35999999999Fee schedule114.89999999999Fee schedule114.89999999999Fee schedule143.280.72999999999 Percent of total billed charges145.670.732999999999 Percent of total billed charges169.150.85999999999 Percent of total billed charges179.10.9999999999 Percent of total billed charges70999999999 Fee schedule70179.1
Procalcitonin33584145CDM84145CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges133.92999999999Fee schedule148.88999999999Fee schedule148.88999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70275.4
B684207CDM84207CPT300RCboth16397.897.80.6999999999 Percent of total billed charges140.45999999999Fee schedule156.14999999999Fee schedule156.14999999999Fee schedule117.360.72999999999 Percent of total billed charges119.320.732999999999 Percent of total billed charges138.550.85999999999 Percent of total billed charges146.70.9999999999 Percent of total billed charges70999999999 Fee schedule70156.14
B284252CDM84252CPT300RCboth12273.273.20.6999999999 Percent of total billed charges101.18999999999Fee schedule112.49999999999Fee schedule112.49999999999Fee schedule87.840.72999999999 Percent of total billed charges89.30.732999999999 Percent of total billed charges103.70.85999999999 Percent of total billed charges109.80.9999999999 Percent of total billed charges70999999999 Fee schedule70112.49
SHBG30084270CDM84270CPT300RCboth12876.876.80.6999999999 Percent of total billed charges108.67999999999Fee schedule120.81999999999Fee schedule120.81999999999Fee schedule92.160.72999999999 Percent of total billed charges93.70.732999999999 Percent of total billed charges108.80.85999999999 Percent of total billed charges115.20.9999999999 Percent of total billed charges70999999999 Fee schedule70120.81
IGF-133584305CDM84305CPT300RCboth12273.273.20.6999999999 Percent of total billed charges106.28999999999Fee schedule118.16999999999Fee schedule118.16999999999Fee schedule87.840.72999999999 Percent of total billed charges89.30.732999999999 Percent of total billed charges103.70.85999999999 Percent of total billed charges109.80.9999999999 Percent of total billed charges70999999999 Fee schedule70118.16
Thiamine (Vitamin B1)33584425CDM84425CPT300RCboth4929.429.40.6999999999 Percent of total billed charges33.98999999999Fee schedule37.78999999999Fee schedule37.78999999999Fee schedule35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges49999999999 Fee schedule29.449
Thyroid Stimulating Immune Globulin30084445CDM84445CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges254.22999999999Fee schedule282.62999999999Fee schedule282.62999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70282.62
T3 Reverse30084482CDM84482CPT300RCboth5503303300.6999999999 Percent of total billed charges38.46999999999Fee schedule42.76999999999Fee schedule42.76999999999Fee schedule3960.72999999999 Percent of total billed charges402.60.732999999999 Percent of total billed charges467.50.85999999999 Percent of total billed charges4950.9999999999 Percent of total billed charges70999999999 Fee schedule38.46495
Triage Troponin30084484CDM84484CPT300RCboth11066660.6999999999 Percent of total billed charges49.18999999999Fee schedule54.67999999999Fee schedule54.67999999999Fee schedule79.20.72999999999 Percent of total billed charges80.520.732999999999 Percent of total billed charges93.50.85999999999 Percent of total billed charges990.9999999999 Percent of total billed charges70999999999 Fee schedule49.1899
Troponin T3000008CDM84484CPT300RCboth12675.675.60.6999999999 Percent of total billed charges49.18999999999Fee schedule54.67999999999Fee schedule54.67999999999Fee schedule90.720.72999999999 Percent of total billed charges92.230.732999999999 Percent of total billed charges107.10.85999999999 Percent of total billed charges113.40.9999999999 Percent of total billed charges70999999999 Fee schedule49.18113.4
Urine urea nitrogen30084540CDM84540CPT300RCboth11468.468.40.6999999999 Percent of total billed charges23.74999999999Fee schedule26.4999999999Fee schedule26.4999999999Fee schedule82.080.72999999999 Percent of total billed charges83.450.732999999999 Percent of total billed charges96.90.85999999999 Percent of total billed charges102.60.9999999999 Percent of total billed charges70999999999 Fee schedule23.74102.6
Vitamin A30084590CDM84590CPT300RCboth7545450.6999999999 Percent of total billed charges58.02999999999Fee schedule64.5999999999Fee schedule64.5999999999Fee schedule540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges70999999999 Fee schedule4570
HCG, QUANT3358396CDM84702CPT300RCboth5130.630.60.6999999999 Percent of total billed charges43.67999999999Fee schedule48.55999999999Fee schedule48.55999999999Fee schedule36.720.72999999999 Percent of total billed charges37.330.732999999999 Percent of total billed charges43.350.85999999999 Percent of total billed charges45.90.9999999999 Percent of total billed charges51999999999 Fee schedule30.651
HEMATOCRIT#85014CDM85014CPT300RCboth4527270.6999999999 Percent of total billed charges11.85999999999Fee schedule13.18999999999Fee schedule13.18999999999Fee schedule32.40.72999999999 Percent of total billed charges32.940.732999999999 Percent of total billed charges38.250.85999999999 Percent of total billed charges40.50.9999999999 Percent of total billed charges45999999999 Fee schedule11.8545
HEMOGLOBIN#85018CDM85018CPT300RCboth3822.822.80.6999999999 Percent of total billed charges11.85999999999Fee schedule13.18999999999Fee schedule13.18999999999Fee schedule27.360.72999999999 Percent of total billed charges27.820.732999999999 Percent of total billed charges32.30.85999999999 Percent of total billed charges34.20.9999999999 Percent of total billed charges38999999999 Fee schedule11.8538
RETICULOCYTE COUNT335793CDM85045CPT300RCboth4627.627.60.6999999999 Percent of total billed charges20999999999Fee schedule22.24999999999Fee schedule22.24999999999Fee schedule33.120.72999999999 Percent of total billed charges33.670.732999999999 Percent of total billed charges39.10.85999999999 Percent of total billed charges41.40.9999999999 Percent of total billed charges46999999999 Fee schedule2046
ANTI-THROMBIN III LEVEL3358267CDM85300CPT300RCboth218130.8130.80.6999999999 Percent of total billed charges59.27999999999Fee schedule65.89999999999Fee schedule65.89999999999Fee schedule156.960.72999999999 Percent of total billed charges159.580.732999999999 Percent of total billed charges185.30.85999999999 Percent of total billed charges196.20.9999999999 Percent of total billed charges70999999999 Fee schedule59.27196.2
PROTHROMBIN TIME/INR#85610CDM85610CPT300RCboth6941.441.40.6999999999 Percent of total billed charges19.67999999999Fee schedule21.87999999999Fee schedule21.87999999999Fee schedule49.680.72999999999 Percent of total billed charges50.510.732999999999 Percent of total billed charges58.650.85999999999 Percent of total billed charges62.10.9999999999 Percent of total billed charges69999999999 Fee schedule19.6769
LUPUS ANTICOAGULANT3357079CDM85613CPT300RCboth198118.8118.80.6999999999 Percent of total billed charges34.98999999999Fee schedule38.88999999999Fee schedule38.88999999999Fee schedule142.560.72999999999 Percent of total billed charges144.940.732999999999 Percent of total billed charges168.30.85999999999 Percent of total billed charges178.20.9999999999 Percent of total billed charges70999999999 Fee schedule34.98178.2
Central Texas IgE panel30086003CDM86003CPT300RCboth379227.4227.40.6999999999 Percent of total billed charges23.89999999999Fee schedule26.56999999999Fee schedule26.56999999999Fee schedule272.880.72999999999 Percent of total billed charges277.430.732999999999 Percent of total billed charges322.150.85999999999 Percent of total billed charges341.10.9999999999 Percent of total billed charges70999999999 Fee schedule23.89341.1
CRP High Sensitivity86141CDM86141CPT300RCboth8249.249.20.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.273.8
Beta 2 Glycoprotein, 1 antibody30086146CDM86146CPT300RCboth204122.4122.40.6999999999 Percent of total billed charges39.23999999999Fee schedule43.62999999999Fee schedule43.62999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule39.23183.6
ANTI-CARDIOLIPIN IGG IGM33536333CDM86147CPT300RCboth10261.261.20.6999999999 Percent of total billed charges39.23999999999Fee schedule43.62999999999Fee schedule43.62999999999Fee schedule73.440.72999999999 Percent of total billed charges74.660.732999999999 Percent of total billed charges86.70.85999999999 Percent of total billed charges91.80.9999999999 Percent of total billed charges70999999999 Fee schedule39.2391.8
Anti-phosphatidylserine antibody30086148CDM86148CPT300RCboth5030300.6999999999 Percent of total billed charges39.23999999999Fee schedule43.62999999999Fee schedule43.62999999999Fee schedule360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges50999999999 Fee schedule3050
C1 Esterase Inhibitor Protein30086160CDM86160CPT300RCboth14989.489.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule107.280.72999999999 Percent of total billed charges109.070.732999999999 Percent of total billed charges126.650.85999999999 Percent of total billed charges134.10.9999999999 Percent of total billed charges70999999999 Fee schedule70134.1
C Esterase Inhibitor30086161CDM86161CPT300RCboth7545450.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges70999999999 Fee schedule4570
Complement total, CH5030086162CDM86162CPT300RCboth14989.489.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule107.280.72999999999 Percent of total billed charges109.070.732999999999 Percent of total billed charges126.650.85999999999 Percent of total billed charges134.10.9999999999 Percent of total billed charges70999999999 Fee schedule70134.1
ANTI CCP33511173CDM86200CPT300RCboth14989.489.40.6999999999 Percent of total billed charges64.7999999999Fee schedule71.93999999999Fee schedule71.93999999999Fee schedule107.280.72999999999 Percent of total billed charges109.070.732999999999 Percent of total billed charges126.650.85999999999 Percent of total billed charges134.10.9999999999 Percent of total billed charges70999999999 Fee schedule64.7134.1
ANTI DS DNA335255CDM86225CPT300RCboth8249.249.20.6999999999 Percent of total billed charges68.67999999999Fee schedule76.34999999999Fee schedule76.34999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.276.34
Sm Antibody30086235CDM86235CPT300RCboth11066660.6999999999 Percent of total billed charges89.66999999999Fee schedule99.67999999999Fee schedule99.67999999999Fee schedule79.20.72999999999 Percent of total billed charges80.520.732999999999 Percent of total billed charges93.50.85999999999 Percent of total billed charges990.9999999999 Percent of total billed charges70999999999 Fee schedule6699.67
SMITH ANTIBODIES33537923CDM86235CPT300RCboth178106.8106.80.6999999999 Percent of total billed charges89.66999999999Fee schedule99.67999999999Fee schedule99.67999999999Fee schedule128.160.72999999999 Percent of total billed charges130.30.732999999999 Percent of total billed charges151.30.85999999999 Percent of total billed charges160.20.9999999999 Percent of total billed charges70999999999 Fee schedule70160.2
Hu Antibody screen w/ reflex3350001CDM86255CPT300RCboth12474.474.40.6999999999 Percent of total billed charges60.22999999999Fee schedule66.95999999999Fee schedule66.95999999999Fee schedule89.280.72999999999 Percent of total billed charges90.770.732999999999 Percent of total billed charges105.40.85999999999 Percent of total billed charges111.60.9999999999 Percent of total billed charges70999999999 Fee schedule60.22111.6
Myelin Associated Glycoprotien AB Serum30086255CDM86255CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges60.22999999999Fee schedule66.95999999999Fee schedule66.95999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule60.22275.4
Endomysial IgA antibody assay86255CDM86255CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges60.22999999999Fee schedule66.95999999999Fee schedule66.95999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule60.22275.4
LRP4 Antibodies3000003CDM86255CPT300RCboth1428856.8856.80.6999999999 Percent of total billed charges60.22999999999Fee schedule66.95999999999Fee schedule66.95999999999Fee schedule1028.160.72999999999 Percent of total billed charges1045.30.732999999999 Percent of total billed charges1213.80.85999999999 Percent of total billed charges1285.20.9999999999 Percent of total billed charges70999999999 Fee schedule60.221285.2
CA 15-330086300CDM86300CPT300RCboth12575750.6999999999 Percent of total billed charges104.04999999999Fee schedule115.67999999999Fee schedule115.67999999999Fee schedule900.72999999999 Percent of total billed charges91.50.732999999999 Percent of total billed charges106.250.85999999999 Percent of total billed charges112.50.9999999999 Percent of total billed charges70999999999 Fee schedule70115.67
CA 272933529493CDM86300CPT300RCboth257154.2154.20.6999999999 Percent of total billed charges104.04999999999Fee schedule115.67999999999Fee schedule115.67999999999Fee schedule185.040.72999999999 Percent of total billed charges188.120.732999999999 Percent of total billed charges218.450.85999999999 Percent of total billed charges231.30.9999999999 Percent of total billed charges70999999999 Fee schedule70231.3
Immunoassay for tumor antigen86301CDM86301CPT300RCboth12273.273.20.6999999999 Percent of total billed charges104.04999999999Fee schedule115.67999999999Fee schedule115.67999999999Fee schedule87.840.72999999999 Percent of total billed charges89.30.732999999999 Percent of total billed charges103.70.85999999999 Percent of total billed charges109.80.9999999999 Percent of total billed charges70999999999 Fee schedule70115.67
Hep B Antibody Immunity30086317CDM86317CPT300RCboth9054540.6999999999 Percent of total billed charges74.94999999999Fee schedule83.31999999999Fee schedule83.31999999999Fee schedule64.80.72999999999 Percent of total billed charges65.880.732999999999 Percent of total billed charges76.50.85999999999 Percent of total billed charges810.9999999999 Percent of total billed charges70999999999 Fee schedule5483.31
Insulin Antibodies30086337CDM86337CPT300RCboth204122.4122.40.6999999999 Percent of total billed charges86.5999999999Fee schedule96.17999999999Fee schedule96.17999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule70183.6
Islet cell antibody30086341CDM86341CPT300RCboth3602162160.6999999999 Percent of total billed charges86.5999999999Fee schedule96.17999999999Fee schedule96.17999999999Fee schedule259.20.72999999999 Percent of total billed charges263.520.732999999999 Percent of total billed charges3060.85999999999 Percent of total billed charges3240.9999999999 Percent of total billed charges70999999999 Fee schedule70324
ZN Transporter AB3000002CDM86341CPT300RCboth3602162160.6999999999 Percent of total billed charges86.5999999999Fee schedule96.17999999999Fee schedule96.17999999999Fee schedule259.20.72999999999 Percent of total billed charges263.520.732999999999 Percent of total billed charges3060.85999999999 Percent of total billed charges3240.9999999999 Percent of total billed charges70999999999 Fee schedule70324
GAD86341CDM86341CPT300RCboth3602162160.6999999999 Percent of total billed charges86.5999999999Fee schedule96.17999999999Fee schedule96.17999999999Fee schedule259.20.72999999999 Percent of total billed charges263.520.732999999999 Percent of total billed charges3060.85999999999 Percent of total billed charges3240.9999999999 Percent of total billed charges70999999999 Fee schedule70324
IA-2 Antibody Lab3000052CDM86341CPT300RCboth3602162160.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule259.20.72999999999 Percent of total billed charges263.520.732999999999 Percent of total billed charges3060.85999999999 Percent of total billed charges3240.9999999999 Percent of total billed charges70999999999 Fee schedule70324
Lumphocyte Subset Panel 530086361CDM86361CPT300RCboth15090900.6999999999 Percent of total billed charges133.84999999999Fee schedule148.8999999999Fee schedule148.8999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule70148.8
Tissue Transglutaminase Antibody IgA30086364CDM86364CPT300RCboth10060600.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges70999999999 Fee schedule6090
Mitochondrial Antibody w/ Reflex Titer30086381CDM86381CPT300RCboth3420.420.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges34999999999 Fee schedule20.434
Mitochondrea M2 AB IgG3000009CDM86381CPT300RCboth3420.420.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule24.480.72999999999 Percent of total billed charges24.890.732999999999 Percent of total billed charges28.90.85999999999 Percent of total billed charges30.60.9999999999 Percent of total billed charges34999999999 Fee schedule20.434
QUANTIFERON TB GOLD33516603CDM86480CPT300RCboth357214.2214.20.6999999999 Percent of total billed charges309.86999999999Fee schedule344.47999999999Fee schedule344.47999999999Fee schedule257.040.72999999999 Percent of total billed charges261.320.732999999999 Percent of total billed charges303.450.85999999999 Percent of total billed charges321.30.9999999999 Percent of total billed charges70999999999 Fee schedule70344.47
Bordetella Pertussis Antibodies33586615CDM86615CPT300RCboth222133.2133.20.6999999999 Percent of total billed charges65.95999999999Fee schedule73.32999999999Fee schedule73.32999999999Fee schedule159.840.72999999999 Percent of total billed charges162.50.732999999999 Percent of total billed charges188.70.85999999999 Percent of total billed charges199.80.9999999999 Percent of total billed charges70999999999 Fee schedule65.95199.8
Qfever30086638CDM86638CPT300RCboth5030300.6999999999 Percent of total billed charges40.88999999999Fee schedule45.45999999999Fee schedule45.45999999999Fee schedule360.72999999999 Percent of total billed charges36.60.732999999999 Percent of total billed charges42.50.85999999999 Percent of total billed charges450.9999999999 Percent of total billed charges50999999999 Fee schedule3050
EB Virus EARLY ANTIGEN IgGB3356421CDM86663CPT300RCboth3118.618.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
HERPES SIMPLEX 1&2 ANTIBODIES3356447CDM86695CPT300RCboth7746.246.20.6999999999 Percent of total billed charges65.95999999999Fee schedule73.32999999999Fee schedule73.32999999999Fee schedule55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges70999999999 Fee schedule46.273.32
HIV SCREENINGG0432CDM86703CPT300RCboth8249.249.20.6999999999 Percent of total billed charges68.52999999999Fee schedule76.17999999999Fee schedule76.17999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.276.17
HEPATITIS A ANTIBODY, IGG335508CDM86708CPT300RCboth3151891890.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule226.80.72999999999 Percent of total billed charges230.580.732999999999 Percent of total billed charges267.750.85999999999 Percent of total billed charges283.50.9999999999 Percent of total billed charges70999999999 Fee schedule70283.5
Antibody, JCV33586711CDM86711CPT300RCboth1632979.2979.20.6999999999 Percent of total billed charges71.97999999999Fee schedule80.01999999999Fee schedule80.01999999999Fee schedule1175.040.72999999999 Percent of total billed charges1194.620.732999999999 Percent of total billed charges1387.20.85999999999 Percent of total billed charges1468.80.9999999999 Percent of total billed charges70999999999 Fee schedule701468.8
MUMPS ANTIBODY3358624CDM86735CPT300RCboth7746.246.20.6999999999 Percent of total billed charges65.22999999999Fee schedule72.5999999999Fee schedule72.5999999999Fee schedule55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges70999999999 Fee schedule46.272.5
Mycoplasma pneumoniae antibodies30086738CDM86738CPT300RCboth8551510.6999999999 Percent of total billed charges66.21999999999Fee schedule73.6999999999Fee schedule73.6999999999Fee schedule61.20.72999999999 Percent of total billed charges62.220.732999999999 Percent of total billed charges72.250.85999999999 Percent of total billed charges76.50.9999999999 Percent of total billed charges70999999999 Fee schedule5176.5
Trypanosoma cruzi antibody3000005CDM86753CPT300RCboth2551531530.6999999999 Percent of total billed charges40.88999999999Fee schedule45.45999999999Fee schedule45.45999999999Fee schedule183.60.72999999999 Percent of total billed charges186.660.732999999999 Percent of total billed charges216.750.85999999999 Percent of total billed charges229.50.9999999999 Percent of total billed charges70999999999 Fee schedule40.88229.5
Rocky Mountain Fever30086757CDM86757CPT300RCboth12575750.6999999999 Percent of total billed charges96.78999999999Fee schedule107.59999999999Fee schedule107.59999999999Fee schedule900.72999999999 Percent of total billed charges91.50.732999999999 Percent of total billed charges106.250.85999999999 Percent of total billed charges112.50.9999999999 Percent of total billed charges70999999999 Fee schedule70112.5
MEASLES (RUBEOLA)335964CDM86765CPT300RCboth9255.255.20.6999999999 Percent of total billed charges64.41999999999Fee schedule71.6999999999Fee schedule71.6999999999Fee schedule66.240.72999999999 Percent of total billed charges67.340.732999999999 Percent of total billed charges78.20.85999999999 Percent of total billed charges82.80.9999999999 Percent of total billed charges70999999999 Fee schedule55.282.8
COVID-19 Antibody test33586769CDM86769CPT300RCboth13379.879.80.6999999999 Percent of total billed charges47.27999999999Fee schedule52.55999999999Fee schedule52.55999999999Fee schedule95.760.72999999999 Percent of total billed charges97.360.732999999999 Percent of total billed charges113.050.85999999999 Percent of total billed charges119.70.9999999999 Percent of total billed charges70999999999 Fee schedule47.27119.7
Covid-19 Antibody test86769CDM86769CPT300RCboth15391.891.80.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule110.160.72999999999 Percent of total billed charges1120.732999999999 Percent of total billed charges130.050.85999999999 Percent of total billed charges137.70.9999999999 Percent of total billed charges70999999999 Fee schedule70137.7
Toxoplasma Abtibody IgG30086777CDM86777CPT300RCboth5533330.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule39.60.72999999999 Percent of total billed charges40.260.732999999999 Percent of total billed charges46.750.85999999999 Percent of total billed charges49.50.9999999999 Percent of total billed charges55999999999 Fee schedule3355
Toxoplasma Antibody, IgM30086778CDM86778CPT300RCboth5533330.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule39.60.72999999999 Percent of total billed charges40.260.732999999999 Percent of total billed charges46.750.85999999999 Percent of total billed charges49.50.9999999999 Percent of total billed charges55999999999 Fee schedule3355
Treponema pallidum Antibody30086780CDM86780CPT300RCboth5130.630.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule36.720.72999999999 Percent of total billed charges37.330.732999999999 Percent of total billed charges43.350.85999999999 Percent of total billed charges45.90.9999999999 Percent of total billed charges51999999999 Fee schedule30.651
HTLV i / ii AB w/ reflex30086790CDM86790CPT300RCboth4002402400.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule2880.72999999999 Percent of total billed charges292.80.732999999999 Percent of total billed charges3400.85999999999 Percent of total billed charges3600.9999999999 Percent of total billed charges70999999999 Fee schedule70360
Hepatitis C Antibody30086803CDM86803CPT300RCboth9054540.6999999999 Percent of total billed charges71.34999999999Fee schedule79.32999999999Fee schedule79.32999999999Fee schedule64.80.72999999999 Percent of total billed charges65.880.732999999999 Percent of total billed charges76.50.85999999999 Percent of total billed charges810.9999999999 Percent of total billed charges70999999999 Fee schedule5481
Antibody to human leukocyte antigens33586829CDM86829CPT300RCboth234140.4140.40.6999999999 Percent of total billed charges148.38999999999Fee schedule164.95999999999Fee schedule164.95999999999Fee schedule168.480.72999999999 Percent of total billed charges171.290.732999999999 Percent of total billed charges198.90.85999999999 Percent of total billed charges210.60.9999999999 Percent of total billed charges70999999999 Fee schedule70210.6
Blood typing; RBC antigen30086905CDM86905CPT300RCboth4502702700.6999999999 Percent of total billed charges378.08999999999Fee schedule420.32999999999Fee schedule420.32999999999Fee schedule3240.72999999999 Percent of total billed charges329.40.732999999999 Percent of total billed charges382.50.85999999999 Percent of total billed charges4050.9999999999 Percent of total billed charges70999999999 Fee schedule70420.32
CULTURE, E COLI 01573358631CDM87046CPT300RCboth6337.837.80.6999999999 Percent of total billed charges47.2999999999Fee schedule52.47999999999Fee schedule52.47999999999Fee schedule45.360.72999999999 Percent of total billed charges46.120.732999999999 Percent of total billed charges53.550.85999999999 Percent of total billed charges56.70.9999999999 Percent of total billed charges63999999999 Fee schedule37.863
Yersinia Culture33587046CDM87046CPT300RCboth6337.837.80.6999999999 Percent of total billed charges47.2999999999Fee schedule52.47999999999Fee schedule52.47999999999Fee schedule45.360.72999999999 Percent of total billed charges46.120.732999999999 Percent of total billed charges53.550.85999999999 Percent of total billed charges56.70.9999999999 Percent of total billed charges63999999999 Fee schedule37.863
CULTURE SPUTUM3354556CDM87070CPT300RCboth12575750.6999999999 Percent of total billed charges43.09999999999Fee schedule47.9999999999Fee schedule47.9999999999Fee schedule900.72999999999 Percent of total billed charges91.50.732999999999 Percent of total billed charges106.250.85999999999 Percent of total billed charges112.50.9999999999 Percent of total billed charges70999999999 Fee schedule43.09112.5
OVA AND PARASITE ONCE ONLY335681CDM87177CPT300RCboth8249.249.20.6999999999 Percent of total billed charges43.71999999999Fee schedule48.59999999999Fee schedule48.59999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule43.7173.8
Herpes simplex virus culture30087255CDM87255CPT300RCboth3018180.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule21.60.72999999999 Percent of total billed charges21.960.732999999999 Percent of total billed charges25.50.85999999999 Percent of total billed charges270.9999999999 Percent of total billed charges30999999999 Fee schedule1830
Crypto Antigen33587328CDM87328CPT300RCboth9657.657.60.6999999999 Percent of total billed charges59.93999999999Fee schedule66.63999999999Fee schedule66.63999999999Fee schedule69.120.72999999999 Percent of total billed charges70.270.732999999999 Percent of total billed charges81.60.85999999999 Percent of total billed charges86.40.9999999999 Percent of total billed charges70999999999 Fee schedule57.686.4
Hepatitis B surface antigen30087340CDM87340CPT300RCboth7545450.6999999999 Percent of total billed charges51.64999999999Fee schedule57.41999999999Fee schedule57.41999999999Fee schedule540.72999999999 Percent of total billed charges54.90.732999999999 Percent of total billed charges63.750.85999999999 Percent of total billed charges67.50.9999999999 Percent of total billed charges70999999999 Fee schedule4570
HIV 1/2 panel30087389CDM87389CPT300RCboth1751051050.6999999999 Percent of total billed charges120.38999999999Fee schedule133.82999999999Fee schedule133.82999999999Fee schedule1260.72999999999 Percent of total billed charges128.10.732999999999 Percent of total billed charges148.750.85999999999 Percent of total billed charges157.50.9999999999 Percent of total billed charges70999999999 Fee schedule70157.5
Covid rapid antigen test30087426CDM87426CPT300RCboth3118.618.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
Shiga like toxin ag ia30087427CDM87427CPT300RCboth1751051050.6999999999 Percent of total billed charges59.93999999999Fee schedule66.63999999999Fee schedule66.63999999999Fee schedule1260.72999999999 Percent of total billed charges128.10.732999999999 Percent of total billed charges148.750.85999999999 Percent of total billed charges157.50.9999999999 Percent of total billed charges70999999999 Fee schedule59.93157.5
Rapid Covid/Flu test87428CDM87428CPT300RCboth8048480.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule57.60.72999999999 Percent of total billed charges58.560.732999999999 Percent of total billed charges680.85999999999 Percent of total billed charges720.9999999999 Percent of total billed charges70999999999 Fee schedule4872
Borrelia Burgdorfe DNA PCR30087476CDM87476CPT300RCboth293175.8175.80.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule210.960.72999999999 Percent of total billed charges214.480.732999999999 Percent of total billed charges249.050.85999999999 Percent of total billed charges263.70.9999999999 Percent of total billed charges70999999999 Fee schedule70263.7
Chlamydia pneu amp probe30087486CDM87486CPT300RCboth816489.6489.60.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule587.520.72999999999 Percent of total billed charges597.310.732999999999 Percent of total billed charges693.60.85999999999 Percent of total billed charges734.40.9999999999 Percent of total billed charges70999999999 Fee schedule70734.4
Chlamydia trachomatis, urogential30087491CDM87491CPT300RCboth2001201200.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule1440.72999999999 Percent of total billed charges146.40.732999999999 Percent of total billed charges1700.85999999999 Percent of total billed charges1800.9999999999 Percent of total billed charges70999999999 Fee schedule70195.02
CHLAMYDIA AND GC GEN PROBE3356919CDM87491CPT300RCboth204122.4122.40.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule70195.02
URINALYSIS FOR CT/GC DNA, SDA33517305CDM87491CPT300RCboth204122.4122.40.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule70195.02
C Diff Amp probe30087493CDM87493CPT300RCboth3001801800.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule2160.72999999999 Percent of total billed charges219.60.732999999999 Percent of total billed charges2550.85999999999 Percent of total billed charges2700.9999999999 Percent of total billed charges70999999999 Fee schedule70270
GI Panel30087506CDM87506CPT300RCboth1224734.4734.40.6999999999 Percent of total billed charges1067.02999999999Fee schedule1186.22999999999Fee schedule1186.22999999999Fee schedule881.280.72999999999 Percent of total billed charges895.970.732999999999 Percent of total billed charges1040.40.85999999999 Percent of total billed charges1101.60.9999999999 Percent of total billed charges70999999999 Fee schedule701186.22
Mycoplasma pneu amp probe30087581CDM87581CPT300RCboth816489.6489.60.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule587.520.72999999999 Percent of total billed charges597.310.732999999999 Percent of total billed charges693.60.85999999999 Percent of total billed charges734.40.9999999999 Percent of total billed charges70999999999 Fee schedule70734.4
Respiratory Viral Panel, PCR33587633CDM87633CPT300RCboth13007807800.6999999999 Percent of total billed charges500999999999Fee schedule500999999999Fee schedule500999999999Fee schedule9360.72999999999 Percent of total billed charges951.60.732999999999 Percent of total billed charges11050.85999999999 Percent of total billed charges11700.9999999999 Percent of total billed charges70999999999 Fee schedule701170
COVID-19 REFERENCE LAB3350002CDM87635CPT300RCboth2551531530.6999999999 Percent of total billed charges188.38999999999Fee schedule209.43999999999Fee schedule209.43999999999Fee schedule183.60.72999999999 Percent of total billed charges186.660.732999999999 Percent of total billed charges216.750.85999999999 Percent of total billed charges229.50.9999999999 Percent of total billed charges70999999999 Fee schedule70229.5
COVID-19 Inhouse Test30087635CDM87635CPT300RCboth2551531530.6999999999 Percent of total billed charges188.38999999999Fee schedule209.43999999999Fee schedule209.43999999999Fee schedule183.60.72999999999 Percent of total billed charges186.660.732999999999 Percent of total billed charges216.750.85999999999 Percent of total billed charges229.50.9999999999 Percent of total billed charges70999999999 Fee schedule70229.5
MRSA, PCR30087641CDM87641CPT300RCboth2001201200.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule1440.72999999999 Percent of total billed charges146.40.732999999999 Percent of total billed charges1700.85999999999 Percent of total billed charges1800.9999999999 Percent of total billed charges70999999999 Fee schedule70195.02
NOROVIRUS RNA, RT-PCR33519098CDM87798CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70275.4
Monkeypox virus DNA, Qual Real time PCR30087798CDM87798CPT300RCboth306183.6183.60.6999999999 Percent of total billed charges175.43999999999Fee schedule195.02999999999Fee schedule195.02999999999Fee schedule220.320.72999999999 Percent of total billed charges223.990.732999999999 Percent of total billed charges260.10.85999999999 Percent of total billed charges275.40.9999999999 Percent of total billed charges70999999999 Fee schedule70275.4
Genotype dna/rna hep c30087902CDM87902CPT300RCboth10506306300.6999999999 Percent of total billed charges916.22999999999Fee schedule1018.57999999999Fee schedule1018.57999999999Fee schedule7560.72999999999 Percent of total billed charges768.60.732999999999 Percent of total billed charges892.50.85999999999 Percent of total billed charges9450.9999999999 Percent of total billed charges70999999999 Fee schedule701018.57
Tissue Culture Lymphocyte33588230CDM88230CPT300RCboth6503903900.6999999999 Percent of total billed charges582.39999999999Fee schedule647.46999999999Fee schedule647.46999999999Fee schedule4680.72999999999 Percent of total billed charges475.80.732999999999 Percent of total billed charges552.50.85999999999 Percent of total billed charges5850.9999999999 Percent of total billed charges70999999999 Fee schedule70647.46
Chromosome Analysis33588262CDM88262CPT300RCboth7004204200.6999999999 Percent of total billed charges623.13999999999Fee schedule692.74999999999Fee schedule692.74999999999Fee schedule5040.72999999999 Percent of total billed charges512.40.732999999999 Percent of total billed charges5950.85999999999 Percent of total billed charges6300.9999999999 Percent of total billed charges70999999999 Fee schedule70692.74
Cytogenetic studies30088275CDM88275CPT300RCboth2301381380.6999999999 Percent of total billed charges200.75999999999Fee schedule223.18999999999Fee schedule223.18999999999Fee schedule165.60.72999999999 Percent of total billed charges168.360.732999999999 Percent of total billed charges195.50.85999999999 Percent of total billed charges2070.9999999999 Percent of total billed charges70999999999 Fee schedule70223.18
Path Surgical Level 1 G&M33588300CDM88300CPT300RCboth184110.4110.40.6999999999 Percent of total billed charges111.97999999999Fee schedule124.48999999999Fee schedule124.48999999999Fee schedule132.480.72999999999 Percent of total billed charges134.690.732999999999 Percent of total billed charges156.40.85999999999 Percent of total billed charges165.60.9999999999 Percent of total billed charges70999999999 Fee schedule70165.6
Path Surgical Level 2 G&M33588302CDM88302CPT300RCboth186111.6111.60.6999999999 Percent of total billed charges111.97999999999Fee schedule124.48999999999Fee schedule124.48999999999Fee schedule133.920.72999999999 Percent of total billed charges136.150.732999999999 Percent of total billed charges158.10.85999999999 Percent of total billed charges167.40.9999999999 Percent of total billed charges70999999999 Fee schedule70167.4
Path Surgical level 3 G&M3353304CDM88304CPT300RCboth199119.4119.40.6999999999 Percent of total billed charges175.24999999999Fee schedule194.82999999999Fee schedule194.82999999999Fee schedule143.280.72999999999 Percent of total billed charges145.670.732999999999 Percent of total billed charges169.150.85999999999 Percent of total billed charges179.10.9999999999 Percent of total billed charges70999999999 Fee schedule70194.82
CELL COUNT BODY FLUIDS89050CDM89050CPT300RCboth3118.618.60.6999999999 Percent of total billed charges23.63999999999Fee schedule26.28999999999Fee schedule26.28999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
Fecal smear; inhouse30089055CDM89055CPT300RCboth2515150.6999999999 Percent of total billed charges21.36999999999Fee schedule23.75999999999Fee schedule23.75999999999Fee schedule180.72999999999 Percent of total billed charges18.30.732999999999 Percent of total billed charges21.250.85999999999 Percent of total billed charges22.50.9999999999 Percent of total billed charges25999999999 Fee schedule1525
SEND OUT FEE/COLL. & HANDLING99001CDM99001CPT300RCboth4627.627.60.6999999999 Percent of total billed charges22.35999999999Fee schedule24.85999999999Fee schedule24.85999999999Fee schedule33.120.72999999999 Percent of total billed charges33.670.732999999999 Percent of total billed charges39.10.85999999999 Percent of total billed charges41.40.9999999999 Percent of total billed charges46999999999 Fee schedule22.3546
SPECIMEN COLLECTION COVID-19G2023CDMG2023CPT300RCboth2615.615.60.6999999999 Percent of total billed charges25999999999Fee schedule25999999999Fee schedule25999999999Fee schedule18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges26999999999 Fee schedule15.626
SPECIMEN COLLECTION COVID-19 SNFG2024CDMG2024CPT300RCboth2615.615.60.6999999999 Percent of total billed charges25999999999Fee schedule25999999999Fee schedule25999999999Fee schedule18.720.72999999999 Percent of total billed charges19.030.732999999999 Percent of total billed charges22.10.85999999999 Percent of total billed charges23.40.9999999999 Percent of total billed charges26999999999 Fee schedule15.626
NH travel3000050CDMP9604CPT300RCboth15990.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule10.80.72999999999 Percent of total billed charges10.980.732999999999 Percent of total billed charges12.750.85999999999 Percent of total billed charges13.50.9999999999 Percent of total billed charges15999999999 Fee schedule915
UDS Send Out / Handling FeeP9604CDMP9604CPT300RCboth6740.240.20.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule48.240.72999999999 Percent of total billed charges49.040.732999999999 Percent of total billed charges56.950.85999999999 Percent of total billed charges60.30.9999999999 Percent of total billed charges67999999999 Fee schedule40.267
STATE CDC COVID-19 TEST3000001CDMU0001CPT300RCboth15391.891.80.6999999999 Percent of total billed charges131.83999999999Fee schedule146.55999999999Fee schedule146.55999999999Fee schedule110.160.72999999999 Percent of total billed charges1120.732999999999 Percent of total billed charges130.050.85999999999 Percent of total billed charges137.70.9999999999 Percent of total billed charges70999999999 Fee schedule70146.55
Chain of Custody blood draw (draw only)3009999CDM300RCboth10.60.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule0.720.72999999999 Percent of total billed charges0.730.732999999999 Percent of total billed charges0.850.85999999999 Percent of total billed charges0.90.9999999999 Percent of total billed charges1999999999 Fee schedule0.61
CARDIOLIPIN ANTIBODY IGG IGM3353633CDM300RCboth4728.228.20.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule33.840.72999999999 Percent of total billed charges34.40.732999999999 Percent of total billed charges39.950.85999999999 Percent of total billed charges42.30.9999999999 Percent of total billed charges47999999999 Fee schedule28.247
BASIC METABOLIC PANEL-CHEM 880048CDM80048CPT301RCboth179107.4107.40.6999999999 Percent of total billed charges42.28999999999Fee schedule47999999999Fee schedule47999999999Fee schedule128.880.72999999999 Percent of total billed charges131.030.732999999999 Percent of total billed charges152.150.85999999999 Percent of total billed charges161.10.9999999999 Percent of total billed charges70999999999 Fee schedule42.28161.1
ELECTROLYTES80051CDM80051CPT301RCboth9657.657.60.6999999999 Percent of total billed charges35.05999999999Fee schedule38.96999999999Fee schedule38.96999999999Fee schedule69.120.72999999999 Percent of total billed charges70.270.732999999999 Percent of total billed charges81.60.85999999999 Percent of total billed charges86.40.9999999999 Percent of total billed charges70999999999 Fee schedule35.0586.4
COMPREHENSIVE METABOLIC PANEL80053CDM80053CPT301RCboth224134.4134.40.6999999999 Percent of total billed charges52.81999999999Fee schedule58.71999999999Fee schedule58.71999999999Fee schedule161.280.72999999999 Percent of total billed charges163.970.732999999999 Percent of total billed charges190.40.85999999999 Percent of total billed charges201.60.9999999999 Percent of total billed charges70999999999 Fee schedule52.81201.6
OBSTETRIC PANEL33520210CDM80055CPT301RCboth277166.2166.20.6999999999 Percent of total billed charges238.99999999999Fee schedule265.69999999999Fee schedule265.69999999999Fee schedule199.440.72999999999 Percent of total billed charges202.760.732999999999 Percent of total billed charges235.450.85999999999 Percent of total billed charges249.30.9999999999 Percent of total billed charges70999999999 Fee schedule70265.69
LIPID PANEL80061CDM80061CPT301RCboth12273.273.20.6999999999 Percent of total billed charges66.94999999999Fee schedule74.42999999999Fee schedule74.42999999999Fee schedule87.840.72999999999 Percent of total billed charges89.30.732999999999 Percent of total billed charges103.70.85999999999 Percent of total billed charges109.80.9999999999 Percent of total billed charges70999999999 Fee schedule66.94109.8
RENAL FUNCTION PANEL80069CDM80069CPT301RCboth15391.891.80.6999999999 Percent of total billed charges43.42999999999Fee schedule48.27999999999Fee schedule48.27999999999Fee schedule110.160.72999999999 Percent of total billed charges1120.732999999999 Percent of total billed charges130.050.85999999999 Percent of total billed charges137.70.9999999999 Percent of total billed charges70999999999 Fee schedule43.42137.7
HEPATITIS PANEL, ACUTE33510306CDM80074CPT301RCboth2751651650.6999999999 Percent of total billed charges238.15999999999Fee schedule264.75999999999Fee schedule264.75999999999Fee schedule1980.72999999999 Percent of total billed charges201.30.732999999999 Percent of total billed charges233.750.85999999999 Percent of total billed charges247.50.9999999999 Percent of total billed charges70999999999 Fee schedule70264.75
HEPATIC FUNCTION PANEL80076CDM80076CPT301RCboth204122.4122.40.6999999999 Percent of total billed charges40.85999999999Fee schedule45.41999999999Fee schedule45.41999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule40.85183.6
CARBAMAZEPINE(TEGRETAL) LEVEL335329CDM80156CPT301RCboth13983.483.40.6999999999 Percent of total billed charges72.81999999999Fee schedule80.95999999999Fee schedule80.95999999999Fee schedule100.080.72999999999 Percent of total billed charges101.750.732999999999 Percent of total billed charges118.150.85999999999 Percent of total billed charges125.10.9999999999 Percent of total billed charges70999999999 Fee schedule70125.1
CYCLOSPORINE, BLOOD3354845CDM80158CPT301RCboth10764.264.20.6999999999 Percent of total billed charges90.25999999999Fee schedule100.33999999999Fee schedule100.33999999999Fee schedule77.040.72999999999 Percent of total billed charges78.320.732999999999 Percent of total billed charges90.950.85999999999 Percent of total billed charges96.30.9999999999 Percent of total billed charges70999999999 Fee schedule64.2100.33
DIGOXIN80162CDM80162CPT301RCboth15391.891.80.6999999999 Percent of total billed charges66.39999999999Fee schedule73.81999999999Fee schedule73.81999999999Fee schedule110.160.72999999999 Percent of total billed charges1120.732999999999 Percent of total billed charges130.050.85999999999 Percent of total billed charges137.70.9999999999 Percent of total billed charges70999999999 Fee schedule66.39137.7
VALPROIC ACID LEVEL3359167CDM80164CPT301RCboth8249.249.20.6999999999 Percent of total billed charges67.75999999999Fee schedule75.32999999999Fee schedule75.32999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.275.32
GENTAMICIN, PEAK3358582CDM80170CPT301RCboth212127.2127.20.6999999999 Percent of total billed charges81.91999999999Fee schedule91.07999999999Fee schedule91.07999999999Fee schedule152.640.72999999999 Percent of total billed charges155.180.732999999999 Percent of total billed charges180.20.85999999999 Percent of total billed charges190.80.9999999999 Percent of total billed charges70999999999 Fee schedule70190.8
LITHIUM LEVEL335613CDM80178CPT301RCboth4124.624.60.6999999999 Percent of total billed charges33.07999999999Fee schedule36.76999999999Fee schedule36.76999999999Fee schedule29.520.72999999999 Percent of total billed charges30.010.732999999999 Percent of total billed charges34.850.85999999999 Percent of total billed charges36.90.9999999999 Percent of total billed charges41999999999 Fee schedule24.641
DILANTIN80185CDM80185CPT301RCboth1851111110.6999999999 Percent of total billed charges66.28999999999Fee schedule73.68999999999Fee schedule73.68999999999Fee schedule133.20.72999999999 Percent of total billed charges135.420.732999999999 Percent of total billed charges157.250.85999999999 Percent of total billed charges166.50.9999999999 Percent of total billed charges70999999999 Fee schedule66.28166.5
TACRILIMUS FK506 LEVEL33534482CDM80197CPT301RCboth219131.4131.40.6999999999 Percent of total billed charges68.67999999999Fee schedule76.34999999999Fee schedule76.34999999999Fee schedule157.680.72999999999 Percent of total billed charges160.310.732999999999 Percent of total billed charges186.150.85999999999 Percent of total billed charges197.10.9999999999 Percent of total billed charges70999999999 Fee schedule68.67197.1
THEOPHYLLINE80198CDM80198CPT301RCboth9657.657.60.6999999999 Percent of total billed charges70.72999999999Fee schedule78.62999999999Fee schedule78.62999999999Fee schedule69.120.72999999999 Percent of total billed charges70.270.732999999999 Percent of total billed charges81.60.85999999999 Percent of total billed charges86.40.9999999999 Percent of total billed charges70999999999 Fee schedule57.686.4
TOBRAMYCIN40584RCDM80200CPT301RCboth173103.8103.80.6999999999 Percent of total billed charges80.59999999999Fee schedule89.6999999999Fee schedule89.6999999999Fee schedule124.560.72999999999 Percent of total billed charges126.640.732999999999 Percent of total billed charges147.050.85999999999 Percent of total billed charges155.70.9999999999 Percent of total billed charges70999999999 Fee schedule70155.7
TOPIRAMATE LEVEL33530965CDM80201CPT301RCboth194116.4116.40.6999999999 Percent of total billed charges59.6999999999Fee schedule66.26999999999Fee schedule66.26999999999Fee schedule139.680.72999999999 Percent of total billed charges142.010.732999999999 Percent of total billed charges164.90.85999999999 Percent of total billed charges174.60.9999999999 Percent of total billed charges70999999999 Fee schedule59.6174.6
VANCOMYCIN, TROUGH3358579CDM80202CPT301RCboth8249.249.20.6999999999 Percent of total billed charges67.75999999999Fee schedule75.32999999999Fee schedule75.32999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.275.32
LEVETIRACETAM LEVEL33515142CDM80299CPT301RCboth13480.480.40.6999999999 Percent of total billed charges68.48999999999Fee schedule76.13999999999Fee schedule76.13999999999Fee schedule96.480.72999999999 Percent of total billed charges98.090.732999999999 Percent of total billed charges113.90.85999999999 Percent of total billed charges120.60.9999999999 Percent of total billed charges70999999999 Fee schedule68.48120.6
THERAPEUTIC DRUG LEVEL33522060CDM80299CPT301RCboth13480.480.40.6999999999 Percent of total billed charges68.48999999999Fee schedule76.13999999999Fee schedule76.13999999999Fee schedule96.480.72999999999 Percent of total billed charges98.090.732999999999 Percent of total billed charges113.90.85999999999 Percent of total billed charges120.60.9999999999 Percent of total billed charges70999999999 Fee schedule68.48120.6
ZONISAMIDE LEVEL33537852CDM80299CPT301RCboth13480.480.40.6999999999 Percent of total billed charges68.48999999999Fee schedule76.13999999999Fee schedule76.13999999999Fee schedule96.480.72999999999 Percent of total billed charges98.090.732999999999 Percent of total billed charges113.90.85999999999 Percent of total billed charges120.60.9999999999 Percent of total billed charges70999999999 Fee schedule68.48120.6
URINE DRUG SCREEN80100CDM80305CPT301RCboth7746.246.20.6999999999 Percent of total billed charges41.98999999999Fee schedule46.68999999999Fee schedule46.68999999999Fee schedule55.440.72999999999 Percent of total billed charges56.360.732999999999 Percent of total billed charges65.450.85999999999 Percent of total billed charges69.30.9999999999 Percent of total billed charges70999999999 Fee schedule41.9870
DRUGS OF ABUSE, URINE3352126CDM80307CPT301RCboth2551531530.6999999999 Percent of total billed charges223.94999999999Fee schedule248.96999999999Fee schedule248.96999999999Fee schedule183.60.72999999999 Percent of total billed charges186.660.732999999999 Percent of total billed charges216.750.85999999999 Percent of total billed charges229.50.9999999999 Percent of total billed charges70999999999 Fee schedule70248.96
ALCOHOL, ETHANOL, BLOOD335443CDM80320CPT301RCboth204122.4122.40.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule146.880.72999999999 Percent of total billed charges149.330.732999999999 Percent of total billed charges173.40.85999999999 Percent of total billed charges183.60.9999999999 Percent of total billed charges70999999999 Fee schedule70183.6
SALICYLATE LEVEL335805CDM80329CPT301RCboth13379.879.80.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule95.760.72999999999 Percent of total billed charges97.360.732999999999 Percent of total billed charges113.050.85999999999 Percent of total billed charges119.70.9999999999 Percent of total billed charges70999999999 Fee schedule70119.7
ACETAMINOPHEN LEVEL82003CDM80329CPT301RCboth188112.8112.80.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule135.360.72999999999 Percent of total billed charges137.620.732999999999 Percent of total billed charges159.80.85999999999 Percent of total billed charges169.20.9999999999 Percent of total billed charges70999999999 Fee schedule70169.2
C PEPTIDE335372CDM80432CPT301RCboth7754654650.6999999999 Percent of total billed charges675.39999999999Fee schedule750.84999999999Fee schedule750.84999999999Fee schedule5580.72999999999 Percent of total billed charges567.30.732999999999 Percent of total billed charges658.750.85999999999 Percent of total billed charges697.50.9999999999 Percent of total billed charges70999999999 Fee schedule70750.84
FACTOR V MUTAION ANALYSIS33522722CDM81241CPT301RCboth216129.6129.60.6999999999 Percent of total billed charges212999999999Fee schedule212999999999Fee schedule212999999999Fee schedule155.520.72999999999 Percent of total billed charges158.110.732999999999 Percent of total billed charges183.60.85999999999 Percent of total billed charges194.40.9999999999 Percent of total billed charges70999999999 Fee schedule70212
HFE Gene Mutation33535079CDM81256CPT301RCboth377226.2226.20.6999999999 Percent of total billed charges326.78999999999Fee schedule363.28999999999Fee schedule363.28999999999Fee schedule271.440.72999999999 Percent of total billed charges275.960.732999999999 Percent of total billed charges320.450.85999999999 Percent of total billed charges339.30.9999999999 Percent of total billed charges70999999999 Fee schedule70363.28
ACETONE82009CDM82009CPT301RCboth4325.825.80.6999999999 Percent of total billed charges21.84999999999Fee schedule24.28999999999Fee schedule24.28999999999Fee schedule30.960.72999999999 Percent of total billed charges31.480.732999999999 Percent of total billed charges36.550.85999999999 Percent of total billed charges38.70.9999999999 Percent of total billed charges43999999999 Fee schedule21.8443
ALBUMIN82040CDM82040CPT301RCboth3219.219.20.6999999999 Percent of total billed charges24.74999999999Fee schedule27.5999999999Fee schedule27.5999999999Fee schedule23.040.72999999999 Percent of total billed charges23.420.732999999999 Percent of total billed charges27.20.85999999999 Percent of total billed charges28.80.9999999999 Percent of total billed charges32999999999 Fee schedule19.232
MICROALBUMIN82044CDM82044CPT301RCboth4929.429.40.6999999999 Percent of total billed charges22.86999999999Fee schedule25.42999999999Fee schedule25.42999999999Fee schedule35.280.72999999999 Percent of total billed charges35.870.732999999999 Percent of total billed charges41.650.85999999999 Percent of total billed charges44.10.9999999999 Percent of total billed charges49999999999 Fee schedule22.8649
ALDOSTERONE33517181CDM82088CPT301RCboth388232.8232.80.6999999999 Percent of total billed charges203.72999999999Fee schedule226.48999999999Fee schedule226.48999999999Fee schedule279.360.72999999999 Percent of total billed charges284.020.732999999999 Percent of total billed charges329.80.85999999999 Percent of total billed charges349.20.9999999999 Percent of total billed charges70999999999 Fee schedule70349.2
ALPHA1 Antitrypsin, Quantitative33567710CDM82103CPT301RCboth8551510.6999999999 Percent of total billed charges67.16999999999Fee schedule74.66999999999Fee schedule74.66999999999Fee schedule61.20.72999999999 Percent of total billed charges62.220.732999999999 Percent of total billed charges72.250.85999999999 Percent of total billed charges76.50.9999999999 Percent of total billed charges70999999999 Fee schedule5176.5
ALPHA-1-ATP QUANT & PHENOTYPE33539521CDM82103CPT301RCboth10361.861.80.6999999999 Percent of total billed charges67.16999999999Fee schedule74.66999999999Fee schedule74.66999999999Fee schedule74.160.72999999999 Percent of total billed charges75.40.732999999999 Percent of total billed charges87.550.85999999999 Percent of total billed charges92.70.9999999999 Percent of total billed charges70999999999 Fee schedule61.892.7
ALPHA-FETOPROTEIN SERUM82105CDM82105CPT301RCboth10060600.6999999999 Percent of total billed charges83.86999999999Fee schedule93.23999999999Fee schedule93.23999999999Fee schedule720.72999999999 Percent of total billed charges73.20.732999999999 Percent of total billed charges850.85999999999 Percent of total billed charges900.9999999999 Percent of total billed charges70999999999 Fee schedule6093.23
AFP, TUMOR MARKER335237CDM82105CPT301RCboth10261.261.20.6999999999 Percent of total billed charges83.86999999999Fee schedule93.23999999999Fee schedule93.23999999999Fee schedule73.440.72999999999 Percent of total billed charges74.660.732999999999 Percent of total billed charges86.70.85999999999 Percent of total billed charges91.80.9999999999 Percent of total billed charges70999999999 Fee schedule61.293.23
AFP, MATERNAL SERUM3355059CDM82105CPT301RCboth7042420.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule50.40.72999999999 Percent of total billed charges51.240.732999999999 Percent of total billed charges59.50.85999999999 Percent of total billed charges630.9999999999 Percent of total billed charges70999999999 Fee schedule4270
AMMONIA82140CDM82140CPT301RCboth14385.885.80.6999999999 Percent of total billed charges72.85999999999Fee schedule80.99999999999Fee schedule80.99999999999Fee schedule102.960.72999999999 Percent of total billed charges104.680.732999999999 Percent of total billed charges121.550.85999999999 Percent of total billed charges128.70.9999999999 Percent of total billed charges70999999999 Fee schedule70128.7
AMYLASE (SERUM/URINE)82150CDM82150CPT301RCboth8249.249.20.6999999999 Percent of total billed charges32.41999999999Fee schedule36.03999999999Fee schedule36.03999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule32.4173.8
ANTIOTENSIN-1-CONVERT ENZYME335683CDM82164CPT301RCboth9054540.6999999999 Percent of total billed charges73999999999Fee schedule81.15999999999Fee schedule81.15999999999Fee schedule64.80.72999999999 Percent of total billed charges65.880.732999999999 Percent of total billed charges76.50.85999999999 Percent of total billed charges810.9999999999 Percent of total billed charges70999999999 Fee schedule5481.15
ARSENIC33536485ACDM82175CPT301RCboth12575750.6999999999 Percent of total billed charges94.83999999999Fee schedule105.43999999999Fee schedule105.43999999999Fee schedule900.72999999999 Percent of total billed charges91.50.732999999999 Percent of total billed charges106.250.85999999999 Percent of total billed charges112.50.9999999999 Percent of total billed charges70999999999 Fee schedule70112.5
BETA-2-MICROGLOBLIN335852CDM82232CPT301RCboth261156.6156.60.6999999999 Percent of total billed charges80.89999999999Fee schedule89.92999999999Fee schedule89.92999999999Fee schedule187.920.72999999999 Percent of total billed charges191.050.732999999999 Percent of total billed charges221.850.85999999999 Percent of total billed charges234.90.9999999999 Percent of total billed charges70999999999 Fee schedule70234.9
BILIRUBIN TOTAL82247CDM82247CPT301RCboth3118.618.60.6999999999 Percent of total billed charges25.07999999999Fee schedule27.87999999999Fee schedule27.87999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
BILIRUBIN DIRECT82248CDM82248CPT301RCboth3118.618.60.6999999999 Percent of total billed charges25.07999999999Fee schedule27.87999999999Fee schedule27.87999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
OCCULT BLOOD (STOOLX3)82270CDM82270CPT301RCboth4728.228.20.6999999999 Percent of total billed charges16.26999999999Fee schedule18.07999999999Fee schedule18.07999999999Fee schedule33.840.72999999999 Percent of total billed charges34.40.732999999999 Percent of total billed charges39.950.85999999999 Percent of total billed charges42.30.9999999999 Percent of total billed charges47999999999 Fee schedule16.2647
OCCULT BLOOD, OTHER82271CDM82271CPT301RCboth4325.825.80.6999999999 Percent of total billed charges16.26999999999Fee schedule18.07999999999Fee schedule18.07999999999Fee schedule30.960.72999999999 Percent of total billed charges31.480.732999999999 Percent of total billed charges36.550.85999999999 Percent of total billed charges38.70.9999999999 Percent of total billed charges43999999999 Fee schedule16.2643
OCCULT BLOOD,FECAL,SINGLE COLL82272CDM82272CPT301RCboth2716.216.20.6999999999 Percent of total billed charges16.26999999999Fee schedule18.07999999999Fee schedule18.07999999999Fee schedule19.440.72999999999 Percent of total billed charges19.760.732999999999 Percent of total billed charges22.950.85999999999 Percent of total billed charges24.30.9999999999 Percent of total billed charges27999999999 Fee schedule16.227
CALCIUM, URINE W/CREAT, RANDOM3351633CDM82310CPT301RCboth3118.618.60.6999999999 Percent of total billed charges25.8999999999Fee schedule28.68999999999Fee schedule28.68999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
CALCIUM82310CDM82310CPT301RCboth3219.219.20.6999999999 Percent of total billed charges25.8999999999Fee schedule28.68999999999Fee schedule28.68999999999Fee schedule23.040.72999999999 Percent of total billed charges23.420.732999999999 Percent of total billed charges27.20.85999999999 Percent of total billed charges28.80.9999999999 Percent of total billed charges32999999999 Fee schedule19.232
CALCIUM, IONIZED82330CDM82330CPT301RCboth8249.249.20.6999999999 Percent of total billed charges68.37999999999Fee schedule76.01999999999Fee schedule76.01999999999Fee schedule59.040.72999999999 Percent of total billed charges60.020.732999999999 Percent of total billed charges69.70.85999999999 Percent of total billed charges73.80.9999999999 Percent of total billed charges70999999999 Fee schedule49.276.01
CALCIUM, 24 HR URINE33582340CDM82340CPT301RCboth4124.624.60.6999999999 Percent of total billed charges30.13999999999Fee schedule33.5999999999Fee schedule33.5999999999Fee schedule29.520.72999999999 Percent of total billed charges30.010.732999999999 Percent of total billed charges34.850.85999999999 Percent of total billed charges36.90.9999999999 Percent of total billed charges41999999999 Fee schedule24.641
KIDNEY STONE ANALYSIS335261CDM82365CPT301RCboth11267.267.20.6999999999 Percent of total billed charges64.45999999999Fee schedule71.64999999999Fee schedule71.64999999999Fee schedule80.640.72999999999 Percent of total billed charges81.980.732999999999 Percent of total billed charges95.20.85999999999 Percent of total billed charges100.80.9999999999 Percent of total billed charges70999999999 Fee schedule64.45100.8
CARBON DIOXIDE (CO2)82374CDM82374CPT301RCboth3219.219.20.6999999999 Percent of total billed charges24.44999999999Fee schedule27.17999999999Fee schedule27.17999999999Fee schedule23.040.72999999999 Percent of total billed charges23.420.732999999999 Percent of total billed charges27.20.85999999999 Percent of total billed charges28.80.9999999999 Percent of total billed charges32999999999 Fee schedule19.232
CEA335978CDM82378CPT301RCboth11066660.6999999999 Percent of total billed charges94.83999999999Fee schedule105.43999999999Fee schedule105.43999999999Fee schedule79.20.72999999999 Percent of total billed charges80.520.732999999999 Percent of total billed charges93.50.85999999999 Percent of total billed charges990.9999999999 Percent of total billed charges70999999999 Fee schedule66105.43
CATECHOLAMIES, 24HR UNRINE3353014CDM82384CPT301RCboth15090900.6999999999 Percent of total billed charges126.25999999999Fee schedule140.35999999999Fee schedule140.35999999999Fee schedule1080.72999999999 Percent of total billed charges109.80.732999999999 Percent of total billed charges127.50.85999999999 Percent of total billed charges1350.9999999999 Percent of total billed charges70999999999 Fee schedule70140.35
CERUPLASMIN335326CDM82390CPT301RCboth6136.636.60.6999999999 Percent of total billed charges53.69999999999Fee schedule59.69999999999Fee schedule59.69999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule36.661
CHLORIDE, ISE82435CDM82435CPT301RCboth3118.618.60.6999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule22.320.72999999999 Percent of total billed charges22.690.732999999999 Percent of total billed charges26.350.85999999999 Percent of total billed charges27.90.9999999999 Percent of total billed charges31999999999 Fee schedule18.631
CHOLESTEROL#82465CDM82465CPT301RCboth6036360.6999999999 Percent of total billed charges21.73999999999Fee schedule24.15999999999Fee schedule24.15999999999Fee schedule43.20.72999999999 Percent of total billed charges43.920.732999999999 Percent of total billed charges510.85999999999 Percent of total billed charges540.9999999999 Percent of total billed charges60999999999 Fee schedule21.7360
COPPER, RANDOM URINE3358573CDM82525CPT301RCboth7142.642.60.6999999999 Percent of total billed charges62.02999999999Fee schedule68.95999999999Fee schedule68.95999999999Fee schedule51.120.72999999999 Percent of total billed charges51.970.732999999999 Percent of total billed charges60.350.85999999999 Percent of total billed charges63.90.9999999999 Percent of total billed charges70999999999 Fee schedule42.670
FREE CORTISOL, 24HR URINE33511280CDM82530CPT301RCboth12072720.6999999999 Percent of total billed charges83.53999999999Fee schedule92.86999999999Fee schedule92.86999999999Fee schedule86.40.72999999999 Percent of total billed charges87.840.732999999999 Percent of total billed charges1020.85999999999 Percent of total billed charges1080.9999999999 Percent of total billed charges70999999999 Fee schedule70108
CORTISOL AM3354212CDM82533CPT301RCboth10261.261.20.6999999999 Percent of total billed charges81.51999999999Fee schedule90.62999999999Fee schedule90.62999999999Fee schedule73.440.72999999999 Percent of total billed charges74.660.732999999999 Percent of total billed charges86.70.85999999999 Percent of total billed charges91.80.9999999999 Percent of total billed charges70999999999 Fee schedule61.291.8
CPK82550CDM82550CPT301RCboth10261.261.20.6999999999 Percent of total billed charges32.55999999999Fee schedule36.19999999999Fee schedule36.19999999999Fee schedule73.440.72999999999 Percent of total billed charges74.660.732999999999 Percent of total billed charges86.70.85999999999 Percent of total billed charges91.80.9999999999 Percent of total billed charges70999999999 Fee schedule32.5591.8
CPK ISOENZYMES335377CDM82552CPT301RCboth9657.657.60.6999999999 Percent of total billed charges66.98999999999Fee schedule74.46999999999Fee schedule74.46999999999Fee schedule69.120.72999999999 Percent of total billed charges70.270.732999999999 Percent of total billed charges81.60.85999999999 Percent of total billed charges86.40.9999999999 Percent of total billed charges70999999999 Fee schedule57.686.4
CKMB82553CDM82553CPT301RCboth1851111110.6999999999 Percent of total billed charges30.79999999999Fee schedule34.23999999999Fee schedule34.23999999999Fee schedule133.20.72999999999 Percent of total billed charges135.420.732999999999 Percent of total billed charges157.250.85999999999 Percent of total billed charges166.50.9999999999 Percent of total billed charges70999999999 Fee schedule30.79166.5
CREATININE82565CDM82565CPT301RCboth6136.636.60.6999999999 Percent of total billed charges25.62999999999Fee schedule28.48999999999Fee schedule28.48999999999Fee schedule43.920.72999999999 Percent of total billed charges44.650.732999999999 Percent of total billed charges51.850.85999999999 Percent of total billed charges54.90.9999999999 Percent of total billed charges61999999999 Fee schedule25.6261
CREATANINE URINE RANDOM3358459CDM82570CPT301RCboth3722.222.20.6999999999 Percent of total billed charges25.87999999999Fee schedule28.76999999999Fee schedule28.76999999999Fee schedule26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges37999999999 Fee schedule22.237
CREATININE URINE RANDOM33521618CDM82570CPT301RCboth3722.222.20.6999999999 Percent of total billed charges25.87999999999Fee schedule28.76999999999Fee schedule28.76999999999Fee schedule26.640.72999999999 Percent of total billed charges27.080.732999999999 Percent of total billed charges31.450.85999999999 Percent of total billed charges33.30.9999999999 Percent of total billed charges37999999999 Fee schedule22.237
CREATININE CLEARANCE3357943CDM82575CPT301RCboth13480.480.40.6999999999 Percent of total billed charges47.27999999999Fee schedule52.55999999999Fee schedule52.55999999999Fee schedule96.480.72999999999 Percent of total billed charges98.090.732999999999 Percent of total billed charges113.90.85999999999 Percent of total billed charges120.60.9999999999 Percent of total billed charges70999999999 Fee schedule47.27120.6
VITAMIN B12 CHEMISTRY335927CDM8260